Community Health Educator, RN

Job Description: The nurse care manager works collaboratively with physicians and other members of the health care team to improve the health of patients with chronic conditions or complex needs. The position educates patients and caregivers to help them manage their health care needs. The incumbent facilitates communication, coordinates services, addresses barriers, and promotes optimal allocation of resources while balancing clinical quality and cost management. Identifies patient populations using specific screening criteria, medical record review or through referrals for service per department policy/guidelines includes trigger list, timeframes for assessing patient, and pre-screen criteria. Review of medical records, focused reports and/or referral information to gather relevant data per department guidelines. Obtains additional necessary information by interviewing the patient/family/significant other (SO). Assesses patient/member per CMS Condition of Participation (COP) or National Clinical Quality Association (NCQA) standards. Ensures a plan of care is developed and maintained for members receiving care management services consistent with COP/NCQA and department standards. Develops plan of care using established evidence-based care process models or care plans. Incorporates the member's individualized needs and goals during the episode of care and within the benefit plan throughout the care management process. Coordinates and facilitates communication among the member/caregivers /representative, members of the healthcare team, and other relevant parties (e.g. referral physicians, community organizations, post-acute providers, other payers, Sales Team, Employer Groups, etc.). Care Management will actively intervene and resolve/escalate where barriers to service exist across the care continuum. Maintains a current knowledge of community resources. Where necessary performs cost benefit analysis and coordinates. Other clinical duties as assigned. Minimum Qualifications Bachelor's degree in Nursing (BSN) from an accredited institution (degree will be verified). Current RN license in state of practice. Two years of clinical nursing experience. - and - Basic computer skills and knowledge of word processing and spreadsheet software. Preferred Qualifications Case Management Certification. Experience working in clinical care management or with third party payers. - and - Knowledge of care management. - and - Knowledge of health insurance related products. - and - Working understanding of coding, episode of care and length of stay guidelines. - and - Written and verbal communication skills. Physical Requirements: Additional Job Description Interact with others requiring the employee to communicate information. - and - Operate computers and other office equipment requiring the ability to move fingers and hands. - and - See and read computer monitors and documents. - and - Remain sitting or standing for long periods of time to perform work on a computer, telephone, or other equipment. Location: Nevada Central Office Work City: Las Vegas Work State: Nevada Scheduled Weekly Hours: 40