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!
IMMS uses a holistic approach to medical management. Therefore, although they may perform separate functions, the Personal Health Nurse (PHN) and Utilization Management Utilization Management Nurse (UMN) work within a team to move the participant 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, that is assesses the participant, works with the participant, family and physician to identify problems, establish goals and develop plans of care, coordinates services, educates participants, empowers participants to independently self-manage and to make knowledgeable health care decisions. The UMN provides utilization review/pre-certification or pre-notifications on various individuals under designated group health contracts. Both the PHN and UMN work closely with the provider(s) to ensure that services are provided in the most appropriate setting by the appropriate provider(s). Both perform some functions of Personal Health Management and Utilization Management. Additionally, they interface with clients and with IMMS account managers and are responsible for the medical management of designated account(s). Within this description, the title â��Medical Management Nurse: refers to both. All Medical Management Nurses practice within the scope of their licensures.
EDUCATION AND/OR EXPERIENCE REQUIREMENTS
Bachelor degree in a health related field
5 years of UM/CM experience, and CCM preferred.
Registered Nurse license and three to five (3-5) years of diverse clinical experience required.
Current active professional license in the state of residence
Eligibility for unrestricted professional licenses in all states
Competency in Microsoft Word
Competency in using email, attachments
Excellent verbal communication skills with the ability to communicate with participants and communicate professionally with individuals who serve in a variety of functions, i.e. physicians, account managers, brokers, customer service staff, IMMS executive management, other IMMS 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
Excellent organizational and prioritization skills
Excellent time management skills
Ability and willingness to function as part of a team
Ability and willingness to function independently
Flexibility and willingness to change
Understanding of IMMS holistic approach to medical management
Understanding of the clientâ��s (customerâ��s) perspective and needs
Understanding of legislative acts, such as the ADA
Complies with laws and regulations that govern the medical management services.
Adheres to IMMS Policies and Procedures
Follows Policies and Procedures for Personal Health Management and utilization management
Understands of IMMS holistic approach to medical management
Understands the clientâ��s (customerâ��s) perspective and needs
Adheres to of the CMSA Standards of Practice
Advocates for participant to obtain quality health care
Identifies liability issues associated with the performance of medical management
Adheres to CMSA Standards of Practice and Professional Code of Ethics
Job: Conifer Health Solutions
Primary Location: Texas
Other Locations: Alabama,California,Florida,Georgia,Louisiana,Massachusetts,Missouri,Mississippi,North Carolina,Nebraska,Pennsylvania,South Carolina,Tennessee,New Jersey,Washington,Colorado,Montana,Michigan,Washington D.C.,District of Columbia,Washington D.C.,New York,Idaho,Kansas,Kentucky,Iowa,North Dakota,Minnesota,Arkansas,Oregon,South Dakota,Maryland,Arizona,Virginia,Indiana,Illinois,Ohio,Wisconsin,Rhode Island,Connecticut,New Hampshire,Vermont
Job Type: Full-time
Shift Type: Days
Employment practices will not be influenced or affected by an applicantâ��s or employeeâ��s race, color, religion, sex (including pregnancy), national origin, age, disability, genetic information, sexual orientation, gender identity or expression, veteran status or any other legally protected status. Tenet will make reasonable accommodations for qualified individuals with disabilities unless doing so would result in an undue hardship.