HealthPartners is hiring an RN Case Manager. This position exists to provide support to patients, their families, and physicians in addressing medical and social concerns; educate and empower patients and families to make informed personal health care decisions; and facilitate communication between patient, physician, health plan and community. This is a primarily remote position that includes several in-person member visits each week in homes, healthcare facilities, and other community settings throughout the Metro area. ACCOUNTABILITIES: • Member Focus • Ensures all activities are member-focused and individualized, resulting in personalized attention to each patient’s unique needs. • Identifies interventions and resources to assist member reaching personal health related goals. • Identifies patterns and episodes of care that are predictive of future needs and services. • Integration • Integrates clinical and psychosocial information for case identification and individual patient assessment to develop action-oriented and time-specific planning and implementation of appropriate interventions. • Facilitates integration of patient care by encouragement of effective communications between patients, families, providers, health plan and care system programs, and community-based services. • Adheres to department policy and procedure in daily activities. • Coordinates service coverage with appropriate funding sources when indicated. • Works with Supervisor, Case Management, Government Programs department and Member Services department to ensure compliance with Medicare requirements and regulations. • Communication • Effectively communicates with patients and their families to provide them with a better understanding of their health, health care benefits, and health care system. • Effectively and routinely communicates with patients, families, physicians and health care team members to facilitate successful collaboration resulting in high levels of member/patient/family/provider satisfaction. • Provides educational information and materials to members to support preference sensitive decisions. • Provides regular reporting of member outcomes to Case Management leadership according to defined process. • Identifies and promptly reports potentially adverse situations to leadership as outlined in department policy and procedure. • Identifies and promptly reports high cost cases for reinsurance. • Maintains current and accurate documentation and case management files in accordance with Case Management policy and procedure. • Maintains confidentiality of information in accordance with department and corporate policies. • Relationships and Team Building • Establishes and maintains good working relationships within the Case Management department, with other HealthPartners departments, and with other health team participants. • Supports other team members in achieving patient centered goals. • Assists supervisor in maintaining a cohesive Case Management team by contributing to a collaborative, respectful, and diverse environment. • Participates in and contributes to appropriate departmental and/or organizational meetings. • Technology • Maintains knowledge of and effectively uses automated applications and systems. • Identifies deficits in technological literacy and seeks appropriate training under guidance of supervisor. • Maintains maximum individual productivity through proficient use of automated systems. • Personal Development • Participates in ongoing independent study and education-related professional activities to maintain and increase knowledge in the areas of Case Management, patient care services, and benefit packages for development of effective case management skills. • Demonstrates responsiveness to and appreciation of constructive feedback and recommendations for personal growth and development. • Maintains current, active Minnesota nursing licensure. • May maintain current, active nursing licensure in other states as assigned. • Other Duties • Willingly participates in various committees, task forces, projects, and quality improvement teams, as needed and assigned. • Performs other duties as assigned. CURRENT DIMENSION: • Directly reports to Supervisor, Case Management. • Directly manages caseload with anticipation of up to 85 members with complex needs. • Interacts with medical, administrative, and front line staff within and outside the organization in order to collaborate on members care. REQUIRED QUALIFICATIONS: • Registered Nurse with current unrestricted license in the State of Minnesota, BSN preferred. License free of history of restrictions and/or sanctions in the past 10 years in all states with current or past licensure. • Minimum of 3 years clinical practice experience in an acute care setting; minimum of 3 years relevant utilization review, discharge planning, or case management experience; and current clinical knowledge. • Demonstrated effective, independent nursing judgment and skills. • Demonstrated skill and experience in effectively collaborating with care team members, using a high level of expertise in written, oral and interpersonal communication. • Demonstrated working knowledge of quality improvement, utilization management, benefit plans, fiscal management, and various payment methodologies preferred. Understanding of healthcare and/or HMO industry. • Demonstrated skill in effective use and management of automated medical management systems. • Demonstrated flexibility, organization, and appropriate decision-making under challenging situations. • Basic computer skills CHALLENGES: • Maintaining member focus in a rapidly evolving environment. • Influencing team members and colleagues to work collaboratively in achieving the goals and objectives of the Case Management Program. • Contributing a positive team building approach as a member of the Case Management team, and a global member of the Case Management Department. DECISION-MAKING: • Makes independent decisions within the scope of this position’s accountabilities and determines the need for and the timing of consultation with Case Management leadership and/or Medical Director. • Uses professional clinical judgment, organizational knowledge, industry knowledge, and common sense in determining appropriate alternatives for members/patients/families, consulting with leadership and/or Medical Director, when indicated. • Makes recommendations to leadership regarding policy development needs and/or changes.