Care Management Nurse

General Information

Position Purpose

The Care Management Nurse is a member-focused role that helps successfully coordinate the
comprehensive care of members. This position provides customer service, proactive outreach to
members, and administrative support to clinicians and care teams. The Care Management Nurse is
responsible for managing inbound and outbound calls to coordinate appointments, utilizing analytics
to help close gaps in care, supporting patients to meet their goals, coordinating resources to help
patients overcome socioeconomic barriers, and resolving patient issues when possible. This
includes organizing, collecting, reviewing and reporting physical and behavioral health and social
information largely through phone outreach, while demonstrating multicultural sensitivity and
effective communication skills with primarily Medicaid members. This is an individual contributor role
with no direct reports, supervisory responsibilities, or administrative leadership authority. This
position works collaboratively with the Population Health team.

Essential Job Functions

• Participates and assists to serve as community liaison and maintain relationships with key
  individuals in the community and serve as an advocate by assisting to coordinate linkages or
  referrals to improve health, social, and environmental conditions for members.
• Conducts member assessments and compiles information from medical records, internal
  reports, and other resources
• Document the changing needs and conditions of the member and communicate this
  information to care coordinators, community partners, physicians and other appropriate
  individuals.
• Document assessments and member/family response to care coordination interventions at
  the time of the encounter.
• Educate and assist identified members about behaviors that can enhance their health,
  successfully navigating the health system.
• Facilitate access to preventive and disease management health services.
• Assists in developing a plan of management associated with healthcare goals for each
  member addressing the diverse needs in a culturally appropriate way.
• Direct responsibility for managing difficult-to-reach, non-responsive, or non-compliant
  members.
• Develop and maintain a report system for tracking outcomes.
• Communicate member issues requiring interventions to appropriate team members and
  providers.
• Prepare for and support offsite wellness, enrollment, and community-related events with
  enthusiasm and energy which may occur outside of usual working hours
• Maintains confidentiality and uses only the minimum amount of protected health information
  (PHI) necessary to accomplish job related responsibilities. Maintain confidentiality of patient
  information.
• Manages an assigned member caseload independently as an individual contributor, with no
  direct supervisory duties or oversight of other personnel.
• Light housekeeping (shared by all employees).
• Protect Monument’s value by keeping information confidential.
• Review systems and processes and suggest/make modifications to address issues
• Occasional travel is required for conferences and assignments.
• Perform other related duties as necessary for the purpose of ensuring the efficient and
  effective functioning of the organization.

Knowledge, Skills, Abilities, and Other Characteristics

• Must have a minimum of two years’ experience as a licensed registered nurse
• 1+ year of experience in Google G-suite and/or Microsoft Office Suite
• Experience in care coordination or discharge planning
• Strong communication skills, especially verbally (i.e. by phone)
• Ability to develop and manage relationships
• Ability to manage individual workload and collaborate effectively within a team without exercising direct supervisory authority over staff
• Reliable transportation and valid and current drivers license and auto insurance
• One or more years of experience in chronic disease care coordination preferred
• Passion for advocacy and ability to motivate others preferred
• Clear-thinker, problem solver, ability to “get things done” preferred
• Ability to manage multiple tasks at one time and move quickly from one project to another preferred
• Bilingual in English and Spanish preferred
• Brings a high degree of professionalism preferred
• Able to accept feedback in the spirit of growth and continuous improvement preferred
• Must adopt and live the Monument Health core values.

Education and Certifications Requirements

Graduate of an accredited Registered/Professional Nursing program required.
State licensure as a Registered Nurse (RN) required.
Bachelor’s degree in Nursing or Graduate degree preferred.

Monument Health Overview

Monument Health, LLC is a joint venture capitalized in 2015 and owned by Intermountain St. Mary’s Regional Medical Center and Primary Care Partners. Monument Health facilitates the largest and most comprehensive clinically integrated network (CIN) on Colorado’s Western Slope and delivers high-impact population health services. The high performing integrated network and population health services allow for better, more coordinated care and cost containment in the communities it serves.

Monument Health currently manages a network of 100,000+ members across the Western Slope, encompassing Commercial, Medicaid, CHP+, Medicare, Medicare Advantage, and Dual Special Needs (D-SNP) insurance plans with multiple payors. Self-funded employer groups may also utilize the Monument Health network and population health services on their TPA platforms. In addition, Monument Health offers analytics, population health and employee-based wellness programs and services.

Physical Aspects of the Job – Regularly Required to Perform Job Tasks

Physical Requirements 

Lifting Requirements

Working Environment

Vision Requirements

Hearing Requirements

Mental Requirements

OSHA Category Classification: Category III

The normal work routine of this position does not involve exposure to blood, body fluids, or tissues. The person holding this position will not be called upon to perform or assist in emergency medical care or first aid or to be potentially exposed in some way. Category III does include handling of implements, utensils, equipment; using public restrooms and public telephones; and personal contacts such as handshaking.