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Case Manager - RN Nurse - (24173)

Universal Health Services


Location:
RENO, NV
Date:
05/18/2018
2018-05-182018-06-16
Job Code:
24173
Universal Health Services
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Job Details

Deltek Talent Management - Case Manager - RN Nurse - (24173)

Job Details


Case Manager - RN Nurse - (24173)

Facility Name
Prominence Health Plan
Location
RENO, NV 89502 US (Primary)
Career Area
Allied Health
Category
Registered Nurse (RN)
Job Description

Founded in 1978, Universal Health Services, Inc. (UHS)* is one of the nation’s largest and most respected healthcare management companies, operating through its subsidiaries—acute care hospitals, behavioral health facilities and ambulatory centers nationwide. With more than 74,000 people employed by UHS subsidiaries, UHS’s business strategy is to continue to grow by building or purchasing healthcare facilities across the country, while continuing to strengthen UHS’s well-reputed franchise with its customary exceptional service and effective cost control. Our success is driven by a service philosophy based on integrity, competence, compassion, and a responsive management style. UHS has been recognized as a Fortune 500 company and is listed as one of Fortune’s Most Admired Companies. UHS’s Acute Care Division is comprised of 25 high performing hospitals and several ambulatory care facilities across the nation and prides itself on providing superior patient care.

Prominence Health Plan was established in Reno, Nevada in 1993 as a Health Maintenance Organization (HMO) and was originally known as St. Mary’s Health Plans. In 2014, a subsidiary of Universal Health Services, Inc. (UHS) acquired the company and renamed it Prominence Health Plan. In addition to the HMO, Prominence Health Plan also offers Point of Service health plans, a preferred health insurance company that offers Preferred Provider Organization (PPO) health plans, and CDS Group Health, a third-party administrator. In addition, Prominence Health Plan owns the Preferred Health Care Network (PHCN), a local provider network. Prominence Health Plan’s HealthFirst HMO/POS is accredited by the National Committee for Quality Assurance (NCQA), which involves a rigorous review of Prominence Health Plan consumer protection and quality improvement systems. Prominence Health Plan’s access to network providers includes 34 hospital and over 3,500 providers statewide, in addition to providers outside of Nevada through network lease arrangements.

Job Summary:  The Case Manager is a registered nurse who enhances the quality of patient management, maximizes satisfaction and promotes cost-effectiveness. The employee will be accountable for the full patient care cycle. Case manager duties include assessing, planning, implementing, monitoring and evaluating actions required to meet the client’s health and human services needs. The Case Manager will be responsible for providing care that is safe, timely, effective, efficient, equitable, and member-centered in conjunction with the Medical Management Team.   

Job Requirements

Regulatory Requirements:

  • Graduation from an accredited nursing education program; BSN preferred

  • Licensed by the State of Nevada to practice as a registered nurse

  • Minimum of three years of Utilization Review/Case Management experience (required.)

·         Knowledge of CMS Guidelines (preferred)

  • Experience in Medicare Utilization Review/Case Management experience (preferred)

  • Recent (within past 3 years) working knowledge of MCG (Milliman Care Guidelines), required; Interqual guidelines, optional.

  • Minimum of three years in clinical medical/surgical nursing practice within a hospital setting 

Language Skills:

  • Ability to effectively communicate in English, both verbally and in writing.

  • Bilingual (optional)

Skills:

  • Certified Case Manager (CCM) or Certified Professional in Healthcare Quality (CPHQ), preferred

  • Experience executing strategies and organizing and prioritizing multiple projects and relationships with key stakeholders and program implementers.

  • Written and oral communication skills, including large and small group presentations, group facilitation and training.

  • Ability to influence others and work collaboratively with key partners to achieve positive results.

  • Ability to use relevant tools (e.g. word processing, spreadsheet, email and database programs and voicemail).

  • Empathetic, Caring, Compassionate Listener.

  • Excellent computer skills.

  • Able to work with a diverse multicultural and socioeconomic population.

  • Familiarity with health care delivery and/or health insurance programs. 

  • Knowledge of medical terminology. 

  • Strong problem-solving and critical thinking skills.

  • Experience working with the Medicare population segment preferred 

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