Arcadia Healthcare Solutions

  • Pop Health Care Manager (RN)

    Location
    US-IL-Rockford
  • Overview

    Arcadia Solutions is looking for an RN to help us change the Healthcare industry. We are a leader in the Value Based Care services and operations for clients and insurance companies who have shared financial risk and managed quality of care. We represent the provider community while recognizing the needs of insurance-based products and benefits. Our existing clients have used our services to thrive in the real-world of managed capitation and bonus attainment.

    You will assist our clients in navigating the health care system and collaborating with the health care team.  The position will work closely with our clients and members promoting wellness, problem-solving and helping individuals realize their personal goals. The role includes patient outreach, assessments, telephonic utilization review services and documentation in compliance with Federal and state regulations, and the NCQA/URAC standards for client members seeking healthcare treatment and services.

    Responsibilities

    • Obtain and document all medical information, including appropriate Medical Criteria, and complete a timely review of health care services covered by the medical group.
    • Communicate timely written and / or verbal determinations while adhering to company policies and NCQA/URAC standards.
    • Communication and collaboration with the Medical Directors, Peer Reviewers, ordering providers, provider organizations, members and/or their representatives
    • Identify targeted members into organized Population Health Management programs, provide case management services and ensure navigation through the continuum of care
    • Responsible for supporting operational aspects of the division to meet the organization's customer requirements and satisfaction
    • Maintain confidentiality related to all computer programs, medical records and data
    • Monthly attendance and coordination of UM Committee Meetings including: material preparation, minutes, data collection and analysis, reporting and follow-up tasks.
    • Assist with the Quality Improvement studies and participate in quality management activities
    • Rotation in after-hours calls and weekend transition of care calls.
    • Responsible for continued professional growth and education that reflects knowledge and understanding of current nursing care practice as outlined in the Illinois Nurse Practice Act.
    • Other responsibilities as assigned

    Qualifications

    • Registered Nurse with a current Illinois state License
    • Five years of experience in a variety of health care settings.
    • Knowledge of utilization review, managed care and community health.
    • Two or more years of clinical case management, including experience in motivational interviewing
    • Excellent clinical judgment
    • Experience navigating multiple EMR’s
    • Strong organizational, writing and speaking skills necessary
    • Ability to ensure completion of projects and assignments
    • Ability to prioritize and react based on rapidly changing business needs
    • Must have ability to work independently and meet deadlines
    • Computer skills including MS Word, Excel, Access, Outlook, etc.

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