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Disease Manager RN

Company: Highmark Health
Location: Harrisburg
Posted on: February 13, 2019

Job Description:

Company :Highmark IncJob Description : JOB SUMMARY

This job is the primary clinician providing condition education and support services to members with specific health-related conditions that comprise the Organization's disease management programs. Uses clinical and motivational interviewing skills to assess members needs and establish mutually agreeable short and longer term goals. Supports members in developing improved knowledge to enhance self-management skills and adopting positive behavior changes, works with the member to identify and address barriers to adherence to standards of evidence-based medicine to optimize outcomes for these conditions. Identifies if members need assistance in coordinating care and navigating the healthcare system and proactively incorporates lifestyle improvement and prevention opportunities into member interventions and identifies and closes gaps in care.

ESSENTIAL RESPONSIBILITIES


  • Function as a primary educator for members with whom have specific health conditions for which the Organization has formal disease management programs. Across the continuum of services the goal is always to help develop and support the members ability to self-manage and navigate the health care system and to provide members with resources and tools to assist in health-related decision making to optimize their clinical outcomes.
  • Conduct clinical assessments through a variety of approaches that will include telephonic as well as face-to-face interventions depending on the model of care delivery. Clinical assessments with approved assessment tools and protocols address the condition specific health and wellness needs of members. Clinical and motivational interviewing skills are utilized with the goal of effecting members self-management and positive behavior changes to achieve condition related goals.
  • Develop case or condition-specific plans of care using the clinical information system to establish short and long-term goals. Establish a plan for regular contact with each member to review progress and assess for additional needs. Monitor and report care plans and members reached as well as their progress towards program goals to the Organization's primary Complex Care Case Manager RN. Member reports will be provided on a regular (monthly or quarterly) basis as so assigned. Communicate with the members treating provider or other company team members when indicated.
  • Identify on-line, telephonic and clinical resources that can assist the member to achieve and maintain their personal health goals and assists the member to access those services. Identify when members need a more advanced level of intervention or have reached goals and takes appropriate action.
  • Proactively incorporates lifestyle improvement and prevention opportunities into member interactions, coaching and goals; incorporates and assists members in closing any gaps in care.
  • Ensure that all activities are documented and conducted in compliance with applicable business process requirements, regulatory requirements and accreditation standards. Account for progress of members served and is accountable for results.
  • Collaborate with behavioral health and other team members to provide co-management activities for members who require additional services. Participate in ongoing training and educational activities related to medical and behavioral health topics.
  • Other duties as assigned or requested.

    Required

    • High School Diploma/GED
    • 5 years of any combination of Clinical, Case Management and/or Disease/Condition Management experience
    • RN license in PA, WV, and DE is required. At least one of these state licenses must be active at time of hire. Others must be obtained within the first 6 months of employment. Additional state licenses may be required

      Preferred

      • Nursing
      • Advanced training in disease management
      • Advanced training and experience in cognitive behavior therapy (CBT), motivational interviewing, or dialectical behavior therapy (DBT)
      • Experience working with the healthcare needs of diverse populations and understanding of the importance of cultural competency in addressing targeted populations
      • Ability to communicate effectively in more than one language
      • Understanding of the role of lifestyle in disease processes
      • Call center experience desirable

        SKILLS

        • Excellent interpersonal and communication skills
        • Broad knowledge of disease processes
        • Understanding of healthcare costs and the broader healthcare service delivery system
        • Proficient computer skills, including MS Office products
        • Demonstrated ability to handle multiple priorities in a fast paced environment

          Referral Bonus: Level 1

          ----------------------------------------------------------------------------------------

          Highmark Health and its affiliates prohibit discrimination against qualified individuals based on their status as protected veterans or individuals with disabilities, and prohibit discrimination against all individuals based on their race, color, religion, sex, national origin, sexual orientation/gender identity or any other category protected by applicable federal, state or local law. Highmark Health and its affiliates take affirmative action to employ and advance in employment individuals without regard to race, color, religion, sex, national origin, sexual orientation/gender identity, protected veteran status or disability.

          EEO is The Law

          Equal Opportunity Employer Minorities/Women/ProtectedVeterans/Disabled/Sexual Orientation/Gender Identity (http://www1.eeoc.gov/employers/upload/eeoc_self_print_poster.pdf)

          We endeavor to make this site accessible to any and all users. If you would like to contact us regarding the accessibility of our website or need assistance completing the application process, please contact number below.

          For accommodation requests, please call HR Services at 844-242-HR4U or visit HR Services Online at HRServices@highmarkhealth.org

          Keywords: Highmark Health, Harrisburg , Disease Manager RN, Healthcare , Harrisburg, Pennsylvania

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