Insurance Case Manager Jobs in Reno, NV (NOW HIRING)

Responsibilities
Prominence Health is a value-based care organization bridging the gap between affiliated health systems and independent providers, building trust and collaboration between the two. Prominence Health creates value for populations and providers to strengthen integrated partnership, advance market opportunities, and improve outcomes for our patients and members. Founded in 1993, Prominence Health started as a health maintenance organization (HMO) and was acquired by a subsidiary of Universal Health Services, Inc. (UHS) in 2014. Prominence Health serves members, physicians, and health systems across Medicare, Medicare Advantage, Accountable Care Organizations, and commercial payer partnerships. Prominence Health is committed to transforming healthcare delivery by improving health outcomes while controlling costs and enhancing the patient experience.
Learn more at: https://prominence-health.com/
Job Summary:
Under the supervision of the Care Management Clinical Program Manager, the RN In-Clinic Care Manager is responsible for providing care management services for medically and/or socially complex members. The target member population includes individuals with complex medical conditions, multiple hospital readmissions, social-economic, or mental health needs panelled to a specific provider group. The goal of the program is to assist these members in achieving optimal health and/or independence in managing their care. To achieve this goal the RN In-Clinic Care Manager will demonstrate and apply knowledge of the philosophy/principles of comprehensive case management, patient-centered, culturally sensitive care coordination, and management of complex members. The RN In-Clinic Care Manager will adhere to the CMSA Standards of Practice for Case Management.
The In-Clinic Care Management (CM) Model establishes a fully integrated, clinic-embedded approach designed to enhance care coordination, reduce avoidable utilization, and improve outcomes for high-risk and high-need members. By pairing the primary care practice with a RN Care Manager (RNCM) supported by Care Coordinators, the model provides proactive, data-driven, and patient-centered care management-directly supporting organizational goals across Primary Care and the Health Plan.
The RN In-Clinic Care Manager is responsible for developing comprehensive care plans for member and family self-care competence, including motivational assessment, assessing for desired level of involvement, and coaching for adherence to the care plan. The RN In-Clinic Care Manager assesses the member's needs, and creates and monitors a specific individualized care plan, including advance care planning. The RN In-Clinic Care Manager promotes knowledge of the Care Management program to Prominence Health Plan contracted physicians, as well as members. In addition, s/he is responsible for developing and sustaining partnerships with community resources, support agencies, and supporting the initiatives of Prominence by acting as a liaison between Prominence provider and member to achieve mutual goals. Additionally, the position includes participation in efforts associated with the successful implementation and operation of the SNP CM program and that the model of care (MOC) meets or exceeds regulatory and accreditation requirements for the Centers for Medicare and Medicaid Services (CMS), state Medicaid offices (as relevant), and NCQA.
LOCATION: Prominence Wellness Center - 699 Sierra Rose Drive
Benefit Highlights:

• Loan Forgiveness Program
• Challenging and rewarding work environment
• Competitive Compensation & Generous Paid Time Off
• Excellent Medical, Dental, Vision and Prescription Drug Plans
• 401(K) with company match and discounted stock plan
• SoFi Student Loan Refinancing Program
• Career development opportunities within UHS and its 300+ Subsidiaries! • More information is available on our Benefits Guest Website: benefits.uhsguest.com

About Universal Health Services:
One of the nation's largest and most respected providers of hospital and healthcare services, Universal Health Services, Inc. (UHS) has built an impressive record of achievement and performance. During the year, UHS was again recognized as one of the World's Most Admired Companies by Fortune; and listed in Forbes ranking of America's Largest Public Companies. Operating acute care hospitals, behavioral health facilities, outpatient facilities and ambulatory care access points, an insurance offering, a physician network and various related services located all over the U.S. States, Washington, D.C., Puerto Rico and the United Kingdom. www.uhs.com
Qualifications
Qualifications and Requirements:
Education:

• Associate or Bachelor's Degree in Nursing, required.

License & Certifications:

• Active, unrestricted, current, and valid Registered Nurse licenses in the States of Practice (Nevada) required
• Certified Case Manager (CCM), Case Management Nurse - Board Certified (CMGT-BC), Accredited Case Manager - RN (ACM-RN), or Certified Managed Care Nurse (CMCN), preferred

Experience:

• Minimum of three (3) years in clinical nursing practice, required .
• Minimum of three (3) years of Case Management/Transition of Care experience in a managed care outpatient or community environment, preferred.
• Recent working knowledge of Milliman Care Guidelines, preferred.

Skills:

• Experience working with the Medicare and Medicaid population segment, preferred.
• Knowledge of Medicare/ Medicaid processes and compliance standards, preferred.
• Strong clinical triage skills -easily able to triage office hour and post office hour calls to the appropriate level of care.

EEO Statement
All UHS subsidiaries are committed to providing an environment of mutual respect where equal employment opportunities are available to all applicants and teammates. UHS subsidiaries are equal opportunity employers and as such, openly support and fully commit to recruitment, selection, placement, promotion and compensation of individuals without regard to race, color, religion, age, sex (including pregnancy, gender identity, and sexual orientation), genetic information, national origin, disability status, protected veteran status or any other characteristic protected by federal, state or local laws.
We believe that diversity and inclusion among our teammates is critical to our success.
Avoid and Report Recruitment Scams
At UHS and all our subsidiaries, our Human Resources departments and recruiters are here to help prospective candidates by matching skill set and experience with the best possible career path at UHS
and our subsidiaries. During the recruitment process, no recruiter or employee will request financial or personal information (e.g., Social Security Number, credit card or bank information, etc.) from you via email. Our recruiters will not email you from a public webmail client like Hotmail, Gmail, Yahoo Mail, etc.
If you suspect a fraudulent job posting or job-related email mentioning UHS or its subsidiaries, we encourage you to report such concerns to appropriate law enforcement. We encourage you to refer to legitimate UHS and UHS subsidiary career websites to verify job opportunities and not rely on unsolicited calls from recruiters.