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Health Services WellCare - Nursing Careers

Disease Management Nurse Job

Full Job Title: Disease Mgmt Nurse - Kapolei

Job Number: 1701888

Location: Oahu, HI

Date Posted: 5-10-2017

Provides telephonic-based contact with members who have been pre-identified as having chronic disease states. Completes clinical assessments on each member to determine the educational health needs based on their disease process, and to monitor the level of adherence. Provides self-management support including care integration for the members enrolled into the disease management program. Assumes a leadership role within the interdisciplinary team to achieve optimal clinical and resource outcomes. Assesses, plans, implements, coordinates, monitors and evaluates care plans, services and outcomes to maximize the health of members.

Essential Functions:
  • Provides telephonic member assessment as the result of inbound and outbound member phone calls.
  • Completes a comprehensive assessment and develops a care plan utilizing clinical expertise to evaluate the members need for alternative services. Assesses short-term and long-term needs and establishes disease management objectives.
  • Educate and assist members in understanding their disease process in an effort to increase self-management maximize optimal health
  • Emphasizes the importance of health education and teaches member behavior modification techniques
  • Utilize evidenced based guidelines to educate members on their specific disease process
  • Identify members educational needs and mail appropriate educational material to each member
  • Monitor members per results of the clinical assessment on a continual basis
  • Promote and encourage members regarding adherence to their care plan and treatment as set by the caregiver Provide referrals as appropriate.
  • Communicate with providers regarding member needs.
  • Collaborates with Case Managers on cases to review care plans and make changes if necessary.
  • Act as liaison and member advocate between the member and their family, physician and facilities/agencies.
  • Manages 100 active cases based on case intensity and acuity.
  • Interacts continuously with member, family, physician(s), and other providers utilizing clinical knowledge and expertise to determine medical history and current status, Assesses options for care including use of benefits and community resources to update the care plan as needed.
  • Maintains accurate record of disease management activities in the Enterprise Medical Management Automation (EMMA) System using clinical guidelines.
  • Maintains HIPAA standards and confidentiality of protected health information. Reports critical incidents and information regarding quality of care issues.
  • Ensures compliance with all state and federal regulations and guidelines in day-to-day activities.
  • Coordinates community resources with emphasis on the development of natural support system. Coordinates benefits, regulations, laws and public entitlement programs for members.
  • Performs other duties as assigned.
Additional Responsibilities:Candidate Education:
  • Required A High School or GED
  • Preferred A Bachelor's Degree in health administration, nursing or related field
Candidate Experience:
  • Required 2 years of experience in a clinical acute care position(s) in varied health care settings with an expertise in cardiovascular disease, diabetes, asthma, pediatrics etc
  • Required 1 year of experience in disease management
  • Preferred Other Managed care experience
Candidate Skills:
  • Intermediate Ability to work independently
  • Intermediate Ability to drive multiple projects
  • Intermediate Ability to multi-task
  • Intermediate Demonstrated interpersonal/verbal communication skills
  • Intermediate Ability to create, review and interpret treatment plans
  • Intermediate Demonstrated time management and priority setting skills
  • Intermediate Ability to work in a fast paced environment with changing priorities
  • Intermediate Demonstrated negotiation skills
  • Intermediate Ability to effectively present information and respond to questions from families, members, and providers
  • Intermediate Ability to effectively present information and respond to questions from peers and management
  • Intermediate Ability to implement process improvements
Licenses and Certifications:
A license in one of the following is required:
  • Required Licensed Registered Nurse (RN)
Technical Skills:
  • Required Beginner Microsoft Excel
  • Required Beginner Microsoft Word
  • Required Beginner Healthcare Management Systems (Generic)
  • Required Beginner Microsoft Outlook
Languages:
  • Preferred Other Bilingual skills

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Last Updated On: 12/9/2015