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Disease Management RN

Company: WebTPA
Location: Irving
Posted on: June 25, 2022

Job Description:

Job Summary
To improve the health, wellbeing, and satisfaction of patients (and their families) with chronic and complex diseases; monitor patient compliance with current disease-specific clinical guidelines; educate patients and their families on their specific disease process and how best to handle it on an outpatient basis.
Essential Functions


  • The essential functions listed represent the major duties of this role, additional duties may be assigned.
  • Ensures all activities are member-focused and individualized, resulting in personalized attention to each patient's unique needs. (10%)
  • Integrates clinical and psychosocial information for case identification and individual patient assessment in order to develop action-oriented and time-specific planning and implementation of appropriate interventions. (15%)
  • Coordinates strategic planning efforts to ensure that high-risk requirements are fulfilled and that needs are met according to health plan requirements. (15%)
  • Effectively communicates with patients and their families to provide them with a better understanding of their health, health care benefits, and health care system (10%)
  • Leads and coordinates the identification, planning, implementation and evaluation of high-risk program management and population management programs as they relate to the chronic condition management programs (10%)
  • Participates in the integration of disease/population management programs into the care management process for selected high-risk patients. Specifically, integrates disease management interventions focused on client-specific targets after analytical review. (10%)
  • Participates in the development of outcome measurement/benchmarks regarding disease and population management programs. (10%)
  • Assures maintenance and continued improvements for all existing high-risk programs. (10%)
  • Utilizes all marketing and developed materials (health education brochures, patient education literature, etc.) to ensure continuity of care and communication to providers and patients. (10%)
    Required Work Experience
    5+ years related work experience. Experience Details: ---Professional background in clinical nursing and patient assessment. Intensive care or higher-acuity patient experience preferred. ---Prior experience in utilization management or case management preferred, preferably within the managed care environment.

    Required Management Experience
    No supervisory/management experience required

    Required Education
    Graduate of an accredited school of nursing.

    Required Licenses and Certifications
    RN - Registered Nurse - State Licensure And/Or Compact State Licensure Licensure in good standing. Upon Hire
    CCM - Certified Case Manager 1 Year

    Additional Required Qualifications

    Knowledgeable in medical terminology, reasonable and necessary treatment plans, delivery quality health care services and cost containment practices.
    Computer skills.
    Ability to collaborate with cross-operational areas within the organization.
    Good verbal and written communication skills.
    Ability to work as a team member, effectively and collaboratively, with non-clinical teammates.
    Uses, protects, and discloses patients' protected health information (PHI) only in accordance with Health Insurance Portability and Accountability Act (HIPAA) standards.Preferred Education
    Bachelor's degree Bachelor's degree in nursing or other field is preferred

    Additional Preferred Qualifications
    --- Proficiency in maintaining good rapport with other staff members, physicians, health care facilities, clients, and providers. --- Knowledge of managed care in a self-funded employer population is preferred. --- Ability to identify problems such as underutilization or overutilization of services --- Ability to promote and maintain quality care through analysis
    General Physical Demands
    Sedentary work: Exerting up to 10 pounds of force occasionally to move objects. Jobs are sedentary if traversing activities are required only occasionally.

    Physical/Environmental Activities
    Must be able to travel to multiple locations for work (i.e. travel to attend meetings, events, conferences). Occasionally
    We are an Equal Opportunity/Protected Veteran/Disabled Employer committed to creating a diverse, inclusive and equitable culture for our employees and communities.

Keywords: WebTPA, Irving , Disease Management RN, Healthcare , Irving, Texas

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