Complex Care Manager RN

Arizona Priority Care (AZPC) is an Integrated Provider Network focused on providing whole-person care to Senior and Medicaid populations, through advanced value-based models. Our provider network is comprised of more than 6,000 health care providers, including primary and specialty care physicians, hospitals and ancillary providers.  We have operated in the Arizona market for more than 12 years, based in Chandler, Arizona, and are an affiliate of Heritage Provider Network. As a leading value-based provider organization, we are committed to improving the quality of care, providing excellent member and provider experiences all while reducing cost.

The Complex Care Manager (CCM) will demonstrate proficiency in the key components of the care management process. This process includes performing assessments, planning, providing education, facilitation, coordination, monitoring, evaluation, and member advocacy. These services are provided to meet the member’s health needs through face to face and telephonic communication. The CMM will provide resources to assist in promoting quality cost-effective outcomes. This is in accordance to evidence-based practices and guidelines for specific conditions. The CMM will understand and support AZPC’s coordination-focused model.

POSITION DUTIES & RESPONSIBILITIES

• Participates in a systematic process of collecting in-depth information about the member’s situation and functioning. This process is to identify individual needs, educational and cultural background, physical or social determinants in order to develop a comprehensive plan of care that will address those needs utilizing required assessment tools.
• Collaborates with the Primary Care Physician/Specialist to ensure the plan of care promotes patient self-management.
• Performs careful ongoing evaluation and follow-up of the member’s situation in order to monitor and intervene as needed in the member’s immediate and possible future needs.
• Verify patient eligibility.
• Obtains and documents verbal consent before initiating care management services.
• At all times the patient retains the right to refuse services or opt-out of CCM.
• Completes the initial Clinical Social Assessment within 30 days of initial face to face and documents in the EMR.
• The CCM utilizes a disease appropriate care module as a reference source in the development of the Care Plan as indicated.
• The Plan of Care (POC) is developed through evidence-based input from the Clinical Social Assessment (CSA) and risk stratification tool.
• The CCM will develop short-and-long-term goals from the educational needs/barriers to care identified in the assessment and interview process.
• The CCM monitors the POC and evaluates its effectiveness on an ongoing basis.
• Works to coordinate services within the member’s benefit limits and integrates with community resources/services to support the member’s needs.
• The CCM prepares and presents cases weekly to the Interdisciplinary Care Team (ICT).
• Complies with the requirements of Clinical Services Care Management Policies.
• Identifies barriers to efficient care management and notifies manager of suggestions for improvement.
• Identifies and submits to the Quality Department any potential quality issues for review as well as utilization issues; e.g., over/under utilization, delay of service issues, etc.
• Members that are identified as high/frequent utilizers of the Emergency Department (ED) through HIE alerts or claims data, are reminded of the benefits of Urgent Care and also Dispatch Health.
• Demonstrates initiative in problem solving.
• Participates and equally shares in after-hour and week-end coverage for the Care Management Department.
• Strong teamwork philosophy and willingness to accept change proactively.
• Other duties as assigned.

EDUCATION, TRAINING AND EXPERIENCE

• Current, unrestricted AZ Nursing license required. – NBSN RN preferred.
• Knowledge of Medicare, state, and local managed care regulations, prior experience in Managed Care setting preferred.
• 5 years Acute Care or Care Management experience, prior ER or ICU or other relevant clinical role requiring quick critical thinking experience preferred.
• Must have the ability to present clinical information both accurately and confidently.
• Able to communicate effectively and in a professional manner with all levels of internal staff and external customers.
• Ability to be detail-oriented, able to function under pressure and able to prioritize and re-prioritize tasks as needed.
• Ability to work both independently and as part of a team, with minimal supervision.
• Excellent customer service and communication skills, both oral and written.
• Familiarity with Electronic Health Records systems, including NextGen and/or EzCap.

*This role requires FT in-office presence for the first 60 days of employment. Hybrid schedule available after initial training period.*