RN Care Management & Sales Consultant

Job Description:

Select Health is a community health plan serving more than one million members. Select Health’s line of businesses include Medicare, Medicaid, FEHB, Marketplace Qualified Health Plans, and fully funded and self-funded Commercial Employer plans.

This Commercial Care Management Sales Consultant partners with all SelectHealth departments, including Account Managers and Sales team to build and maintain strong relationships with brokers, employers, providers, members and Select Health Stakeholders.
The position participates in actual Care Management and leads special projects for related programs, serves on committees for process improvement and serves as a care management subject matter expert / mentor in Healthy Connections and Select Health. Provides interdepartmental and leadership support for line of business leaders. Ensures effective and efficient operations to exceed the expectations of our members and customers.
This position reports to a Healthy Connections Department Leader and works in close partnership with Commercial and Employer Sales.
This position leads strategy as applicable to assigned role and may lead a team of caregivers.
This position requires occasional travel for sales, presentations, in-office meetings, and training.

Must live in Utah

Essential Functions

• Communicates, collaborates, educates, and demonstrates the value of SelectHealth Utilization and Care Management services and programs to new and existing employer groups, brokers, providers, partners, networks, and other Select Health departments.
• Responsible for creating and presenting Utilization and Care Management reports and content that is compelling and resonates with our target audience (e.g., employee's engagement in care management programs with specific details around progress to goals, anticipated length of stay, anticipated further medical, outcome measures, return on investment, and claims related information.
• Provides Healthy Connections data, expertise, and clinical review for Proposals, projects, presentations, and Request for Information, in partnership with Health Connections Leaders.
• Creates and maintains a positive impression by providing an extraordinary customer and member experience.
• Maintains timely, clear, concise, and accurate communication with client groups and internal and external customers and partners.
• Demonstrates a strong clinical understanding of all aspects of Care and Disease Management programs, functions, and processes, including documentation in the care management operating system.
• Demonstrates understanding of employee populations for each self-funded employer group, including risk factors and utilization patterns.
• Leads process improvement projects related to Care Management for the Commercial and Self-Funded line of business.
• Monitors, evaluates, and assess clinical and claims data related to client groups' employee's information and Identifies members unable to adhere to a medical plan or members that require complex additional assistance and refers or enrolls these members to care management services.
• The position performs Care Management activities, follows processes for enrollment into Care Management and carries a limited Care Management case load.
• Partners with Select Health members, their family, caregivers, and a multi-disciplinary care team in a collaborative process of assessment, planning, facilitation, navigation, coordination, evaluation and advocacy for options and services to meet comprehensive medical, behavioral, and social needs of members and their families while promoting self-management, quality, and cost-effective outcomes.
• Follows the applicable established model of care or care management program policies and procedures to assess, establish and maintain a plan of care which incorporates the member's individualized needs and goals within the benefit plan throughout the care management process.
• Liaison for facilities, providers, and community partners

Skills

• Care Management
• Clinical Expertise
• Customer Service
• Data Analysis
• Excellent Verbal and Written Communication
• Independent and autonomous
• Leadership
• Problem Solving
• Relationship Building
• Technological Savviness

Qualifications

Minimum Qualifications

• Bachelor's degree in nursing (BSN) from an accredited institution (degree will be verified)
• Current RN (Nurse) compact license to practice in all states that are part of the compact and Select Health Region.
• Current and in good standing driver's license with means for transportation to and from members residence, providers, or sites of care.
• Five years of clinical practice experience that may include acute care, quality assurance, home care, community health or occupational health experience.
• Two years of care management experience and demonstrable understanding of health plan related care management regulatory standards (e.g., NCQA care management standards) and/or knowledge of government programs (e.g., Medicare, Medicaid)
• Excellent written, and verbal communication, customer service and conflict resolution skills
• Intermediate hardware skills, ability to customize computer settings and use multiple monitors and capable of independent troubleshooting internet and applications.
• Intermediate computer software and Advanced Microsoft Suite, including PowerPoint, excel, Teams (chat, whiteboard, task tracking) & Outlook.

Preferred Qualifications

• Commission for Case Manager Certification (CCMC)-Case Management Certification-CCM or American Case Management Association-ACMA- Accredited Case Manager-ACM Certification
• Experience working with third party payers.
• Ability to work independently and be flexible in a rapidly changing environment.
• Experience working successfully working in a remote environment or using Advanced Microsoft Suite, including Teams (chat, whiteboard, task tracking) & Outlook.
• Ability to work independently, be initiative-taking, have a cheerful outlook, and be flexible in a rapidly changing environment.

Physical Requirements

• Ongoing need for employees to see and read information, documents, monitors, identify equipment and supplies, and be able to assess customer needs.
• Frequent interactions with colleagues and providers require employees to verbally communicate and hear and understand spoken information, needs, and issues quickly and accurately.
• Manual dexterity of hands and fingers to manipulate complex and delicate equipment with precision and accuracy. This includes frequent computer use for typing and accessing needed information.
• May be expected to sit or stand in a stationary position for a long time.

Location:

SelectHealth - Murray

Work City:

Murray

Work State:

Utah

Scheduled Weekly Hours:

40

The hourly range for this position is listed below. Actual hourly rate dependent upon experience. 

$45.31 - $67.01

We care about your well-being – mind, body, and spirit – which is why we provide our caregivers a generous benefits package that covers a wide range of programs to foster a sustainable culture of wellness that encompasses living healthy, happy, secure, connected, and engaged.

Learn more about our comprehensive benefits package here.

Intermountain Health is an equal opportunity employer. Qualified applicants will receive consideration for employment without regard to race, color, religion, age, sex, sexual orientation, gender identity, national origin, disability or protected veteran status.

At Intermountain Health, we use the artificial intelligence ("AI") platform, HiredScore to improve your job application experience. HiredScore helps match your skills and experiences to the best jobs for you. While HiredScore assists in reviewing applications, all final decisions are made by Intermountain personnel to ensure fairness. We protect your privacy and follow strict data protection rules. Your information is safe and used only for recruitment. Thank you for considering a career with us and experiencing our AI-enhanced recruitment process.

All positions subject to close without notice.