At APS Healthcare, we are passionate about changing behaviors of all constituents in the healthcare system to improve health, optimize clinical quality, and reduce associated costs. Our mission is quite simply to improve the health of those we serve.
APS Healthcare is managing the HMSA QUEST Integrated Health Management Program, which provides comprehensive field and telephonic care management and care coordination services to high and moderate-risk members. This program supports providers and community partners through targeted clinically driven interventions. Members are an integral partner in the treatment team and are supported in making responsible decisions about their healthcare.
APS is seeking a Field-Based RN Care Manager to join this new and exciting program. The RN will provide outreach, case management, education and support to plan members to support healthy lifestyle. The Care Manager will perform clinically based activities to coordinate care between the members, providers and community based health organizations. This position will be based in Maui, HI and requires travel within the assigned locations.
1. Provides continuum of quality care through telephonic and field based outreach, education, medication reconciliation, crisis intervention and other clinically based activities to plan members as specified in their treatment plans. (30%)
2. Conducts assessments, develops case management and crisis plans for medical treatment and/or behavioral modification within the scope of practice. Clinical activities may occur in all community settings or telephonically. (20%)
3. Collaborates and coordinates with member’s medical/health and community based providers (including the PCP, medical professionals, behavioral health specialists, or others as needed) regarding the member’s treatment/discharge needs and plan of care. (20%)
4. Collects clinical data and maintains accurate records of activities. Enters information into database for tracking and metrics purposes. (10%)
5. Monitors and evaluates the services and community based resources necessary to respond to the individual member’s health needs. Supports the efficient and effective utilization of health care resources which may include transportation or escort to medical appointments (10%)
• Collaborates with the Care Management Team to review care management process for members to ensure needs of members are met. (5%)
• Assumes a leadership role within the interdisciplinary team for medically complex members to achieve optimal clinical and resource outcomes. (5%)
Education & Experience
• Associates Degree in Nursing required; Bachelors Degree in Nursing preferred
• Masters Degree in Nursing or healthcare field preferred
• Professional registered nursing clinical licensure required in the state of practice
• Minimum 2-4 years medical care or other relevant health care experience.
• Previous experience providing field based care coordination and/or case management services required.
• Managed care experience preferred
• Previous experience working with SMI or Behavioral Health members preferred