Job Summary:

The Disease Management Nurse will perform telephonic and disease management assessments to empower clients to better understand their illnesses and to self-manage their conditions.

Supervisory Responsibilities:

• None.

Duties/Responsibilities:

• Provides assessment, disease management, education, training, and other clinically based activities to coordinate care among providers, clients, and the community.
• Makes adequate contact with clients with a focus on behavioral goal setting and member-centered support planning. Identifies client resource needs, provides information on possible resources to clients, and makes referrals for clients.
• Collaborates with other health care providers to review actual and proposed medical care and services against established coverage guidelines review criteria.
• Manages network participation, care with specialty networks, care with medical providers, and transfers to alternative levels of care using knowledge of benefit plan design.
• Recommends services for clients using care alternatives available in the community
  and nationally. Identifies potentially unnecessary services and care-delivery settings and recommends alternatives by analyzing clinical protocols.
• Examines clinical programs information to identify members for specific case management
  and/or disease management activities or interventions by using established screening criteria.
• Conducts admission reviews, post-discharge calls, and discharge planning.

Required Skills/Abilities:

• Strong verbal and written communication skills.
• Experience with clinical-care computer systems, data entry, and call center environments preferred.
• Focused customer service skills and excellent problem-solving skills.
• Ability to use critical thinking and to problem solve in a nonthreatening manner.

Education and Experience:

• Registered nurse with active, unrestricted state license.
• Minimum of one to two years of experience in related medical services including experience with quality improvement, medical record reviews, disease management, and/or primary care case management.
• Two years of clinical nursing experience and clinical experience in an area such as behavioral health, medical, surgical, critical care, home health, or skilled nursing.
• Experience with mental health/addictive disease services strongly preferred.

Physical Requirements:

• Prolonged periods of sitting at a desk and working on a computer.
• May require prolonged periods of standing, bending, or walking.
• Must be able to lift up to 50 pounds at times with or without assistance.