JOB SUMMARY
CCCS uses a holistic approach to medical management.
The Personal Health Nurse
(PHN) works within a team to move the member through the continuum of medical
management with the goals of facilitating quality health care through the most
cost-effective means.
The PHN performs the Personal Health Management process:
assess the member; work with the member, family and physician to identify
problems; establish goals and develop plans of care; coordinate services;
educate members; and empower members to independently self-manage and to make
knowledgeable health care decisions. The PHN works closely with the provider(s)
to ensure that services are provided in the most appropriate setting by the
appropriate provider(s) by performing functions of Personal Health Management as
well as some functions of Utilization Management.
Additionally, the PHN
interfaces with clients and with CCCS client managers and are responsible for
the medical management of designated client(s).
All Medical Management Nurses
practice within the scope of their licensures.
ESSENTIAL DUTIES AND RESPONSIBILITIES
Include the following. Others may be assigned.
* Manages accounts using the 4-Prong approach, meeting expected number of
billable hours and using Conifer Value Based Care tools ( CCOO) according to
standard protocol.
Documents accurate Status, Sub-status, Patient Severity,
Medical Management Acuity
* Reviews daily calendar for new episodes and tasks due, prioritizes tasks on
calendar
* Completes a Personal Health Management assessment incorporating analysis of
clinical claim chart, discussions with the member and the physician’s
assessment and treatment plan
* Determines and documents member’s goals, engages the member in the personal
health management process.
Develops an ongoing individualized plan of care
with timeframes, reasonable and appropriate expected outcomes, specific
planned interventions and member’s goals.
Follows through with interventions
and documents outcomes in Current Clinical Status section of care plan
* Engages the PCP and treating physicians in the personal health management
process, Collaborates with the member and PCP in development of an
individualized plan of care
* Closes episodes as indicated, i.e. evaluates “Impactability” among other
indications for closure.
KNOWLEDGE, SKILLS, ABILITIES
To perform this job successfully, an individual must be able to perform each
essential duty satisfactorily. The requirements listed below are representative
of the knowledge, skill and/or ability required. Reasonable accommodations may
be made to enable individuals with disabilities to perform the essential
functions.
* Understanding of CCCS holistic approach to medical management
* Understanding of the client’s (customer’s) perspective and needs
* Understanding of legislative acts, such as the ADA
* Competency in Word
* Competency using email, attachments
* Excellent verbal communication skills with the ability to communicate with
members and communicate professionally with individuals who serve in a
variety of functions, i.e. physicians, client managers,
customer service
staff,
CCCS executive management, other CCCS Medical Management nurses,
hospital utilization review nurses, etc.
* Excellent written communication skills with the ability to write in a
professional, business manner
* Ability to analyze and resolve complex problems
* General understanding of cost containment and how it relates to medical
management
* Excellent organizational, prioritization, and time management skills
* Ability and willingness to function both independently and as part of a team
Conifer requires its candidates, as applicable and as permitted by law, to
obtain and provide confirmation of all required vaccinations and screenings
prior to the start of employment.
This may include, but is not limited to, the
COVID-19 vaccination, influenza vaccination, and/or any future required vaccines
and screenings.
EDUCATION / EXPERIENCE
Include minimum education, technical training, and/or experience preferred to
perform the job.
* Bachelor’s degree in a health-related field
* Five (5) years of UM/CM experience preferred
* Three to five (3-5) years of diverse clinical experience required
* CCM preferred
REQUIRED CERTIFICATIONS/LICENSURE
Include minimum certification required to perform the job.
* RN (Registered Nurse) license required
* Current active professional license in the state of residence
* Eligibility for unrestricted professional licenses in all states
PHYSICAL DEMANDS
The physical demands described here are representative of those that must be met
by an employee to successfully perform the essential functions of this job.
Reasonable accommodations may be made to enable individuals with disabilities to
perform the essential functions.
* Must be able to work in sitting position, use computer and answer telephone
* Ability to travel
* Includes ability to walk through hospital-based departments across broad
campus settings, including Emergency Department environments
WORK ENVIRONMENT
The work environment characteristics described here are representative of those
an employee encounters while performing the essential functions of this job.
Reasonable accommodations may be made to enable individuals with disabilities to
perform the essential functions.
* Remote Work Environment
TRAVEL
* Approximately 5 – 30 % travel may be required dependent on the client
assigned
As a part of the Tenet and Catholic Health Initiatives family, Conifer Health
brings 30 years of healthcare industry expertise to clients in more than 135
local regions nationwide. We help our clients strengthen their financial and
clinical performance, serve their communities, and succeed at the business of
healthcare. Conifer Health helps organizations transition from volume to
value-based care, enhance the consumer and patient healthcare experience and
improve quality, cost and access to healthcare. Are you ready to be part of our
solutions? Welcome to the company that gives you the resources and incentives to
redefine healthcare services, with a competitive benefits package and leadership
to take your career to the next step!
Compensation and Benefit Information
Compensation
* Pay: $64,168.00 - $96,262.00 annually. Compensation depends on location,
qualifications, and experience.
* Management level positions may be eligible for sign-on and relocation
bonuses.
Benefits
Conifer offers the following benefits, subject to employment status:
* Medical, dental, vision, disability, life, and business travel insurance
* Paid time off (vacation & sick leave) – min of 12 days per year, accrued
accrue at a rate of approximately 1.84 hours per 40 hours worked.
* 401k with up to 6% employer match
* 10 paid holidays per year
* Health savings accounts, healthcare & dependent flexible spending accounts
* Employee Assistance program, Employee discount program
* Voluntary benefits include pet insurance, legal insurance, accident and
critical illness insurance, long term care, elder & childcare, AD&D, auto &
home insurance.
* For Colorado employees, Conifer offers paid leave in accordance with
Colorado’s Healthy Families and Workplaces Act.
