Complex Care Manager RN

Arizona Priority Care - Chandler, AZ

Full-time - Mid Level

Chandler, AZ

5,001-10,000 employees

Nursing and Residential Care Facilities

About the position

The Complex Care Manager (CCM) at Arizona Priority Care is responsible for providing whole-person care to Senior and Medicaid populations through advanced value-based models. This role involves performing assessments, planning, education, facilitation, coordination, monitoring, evaluation, and member advocacy to meet the health needs of members. The CCM will work closely with healthcare providers to develop and implement comprehensive care plans, ensuring quality and cost-effective outcomes.

Responsibilities

• Participates in a systematic process of collecting in-depth information about the member's situation and functioning.
• Collaborates with the Primary Care Physician/Specialist to ensure the plan of care promotes patient self-management.
• Performs ongoing evaluation and follow-up of the member's situation to monitor and intervene as needed.
• Verifies patient eligibility and obtains verbal consent before initiating care management services.
• Completes the initial Clinical Social Assessment within 30 days of initial face-to-face contact and documents in the EMR.
• Utilizes a disease-appropriate care module as a reference source in the development of the Care Plan.
• Develops short- and long-term goals from the educational needs/barriers to care identified in the assessment.
• Monitors the Plan of Care and evaluates its effectiveness on an ongoing basis.
• Coordinates services within the member's benefit limits and integrates with community resources/services.
• Prepares and presents cases weekly to the Interdisciplinary Care Team (ICT).
• Identifies barriers to efficient care management and notifies manager of suggestions for improvement.
• Submits potential quality issues for review to the Quality Department.
• Reminds high/frequent utilizers of the Emergency Department about the benefits of Urgent Care and Dispatch Health.
• Demonstrates initiative in problem solving and participates in after-hour and weekend coverage for the Care Management Department.

Requirements

• Current, unrestricted AZ Nursing license required.
• 5 years Acute Care or Care Management experience, with prior ER or ICU experience preferred.
• Knowledge of Medicare, state, and local managed care regulations, with prior experience in a Managed Care setting preferred.
• Ability to present clinical information accurately and confidently.
• Effective communication skills with all levels of internal staff and external customers.
• Detail-oriented with the ability to function under pressure and prioritize tasks.
• Ability to work 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.

Nice-to-haves

• NBSN RN preferred.

Benefits

• Hybrid schedule available after initial training period.