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Resource Nurse Salary in Boise, ID

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Nurse, Licensed Practical
Boise State University, Boise
About Us: Boise State University is located along the banks of the Boise River and a short stroll from the state capitol. We are committed to an innovative, transformative, and equitable educational environment that supports student success, and advances Idaho and the world.Boise State is building an inclusive community of faculty and staff whose unique skills, cultural contributions, work history, and perspectives create a rich and rewarding academic experience for our students. Applications from individuals of all backgrounds and identities are welcomed.Learn more about Boise State and living in Idaho's Treasure Valley at https://www.boisestate.edu/about/ Job Summary/Basic Function: The primary purpose of this position is to provide direct basic patient care functions to assist nursing and medical providers in University Health Services with the examination and/or treatment of patients. This position will be scheduled to work four, 10 hour shifts a week. Level Scope: Regularly works on tasks that are varied and complex. Applies full range and job knowledge; frequently adapts procedures, techniques, tools, materials, and/or equipment to meet specialized needs; may serve as lead; performs broad and/or focused assignments under general supervision; originality and ingenuity are often required to help establish procedures in functional area; relies on experience and judgment to plan and accomplish assigned tasks. Essential Functions: 75% of the time- Patient Care Services Prepare patients for clinic visits performing vital sign check, rooming patient and preparing appropriately for visit. Perform duties including but not limited to EKG's, ear lavage, nebulizer treatments, injections, assisting with minor procedures. Documentation of patient encounters. Assist with training and mentoring of new LPN and RMA staff. Participate in educational in-services and educational opportunities for the LPN/MA staff. Serve as a clinical resource for issues related to nursing care. Prepare for and assist clinicians with medical procedures. Provide patient education at the LPN level. Collect and process off-site medical laboratory specimens. Process pharmaceutical refills. Administer oral, injectable and specific IV medications and fluids. Place and maintain intravenous lines. Participate in patient immunization clinics. Participate in patient allergy injection clinic. Serve in the charge nurse role on a rotating basis with other LPN's. Other duties as assigned. 25% of the time- Nonclinical tasks Lab QA and participation in oversight. Order clinic supplies/devices as directed. Other administrative tasks and assignments as identified. Supply room, autoclaving and other nonclinical assignments as identified. Knowledge, Skills, and Abilities: Knowledge of human behavior and performance. Ability to communicate information and ideas effectively. Ability to adjust actions in relation to others' actions. The incumbent must be self motivated and willing to work both as a team member in the patient treatment areas and be a self starter in contacting the pharmaceutical companies for samples as well as initiating ordering supplies and materials for clinical services. Experience with problem solving and problem resolution. Minimum Qualifications: Licensed as a Licensed Practical Nurse by the state of Idaho or state licensure as a Practical Nurse pursuant to the Nurse Licensure Compact, Idaho Code 54-1418, in one of the following compact states: Arizona, Arkansas, Colorado, Delaware, Iowa, Kentucky, Maine, Maryland, Mississippi, Missouri, Nebraska, New Hampshire, New Mexico, North Carolina, North Dakota, Rhode Island, South Carolina, South Dakota, Tennessee, Texas, Utah, Virginia, or Wisconsin. Preferred Qualifications: Successful completion of an accredited LPN program. Current state of Idaho LPN licensure in good standing. A minimum of 4 years experience in a similar setting. Solid knowledge of back-office clinic operations. Excellent communication and interpersonal skills. Excellent clinical skills within the LPN scope of practice. The ability to hold information in confidence. A focus on patient-centered care and satisfaction. Knowledge of HIPAA privacy laws Salary and Benefits: Salary is $24 an hour, commensurate with experience. Boise State University is committed to offering a benefits package that provides health and financial protection plans as well as resources to promote health and well-being. Our program provides flexibility so you can choose the benefits that are right for you and your family. Learn more about our benefit options at https://www.boisestate.edu/hrs/benefits/. Required Application Materials: Please submit a cover letter indicating your interest and qualifications as well as a resume with employment history and three professional references.Advertised: April 1, 2024 Mountain Daylight Time Applications close: April 29, 2024 11:55 PM Mountain Daylight Time
Behavioral Health Care Management Clinician
Cambia Health, Boise
Behavioral Health Care Management ClinicianRemote within OR, WA, UT, or ID. Candidates outside of these states will not be consideredAre you a Licensed Behavioral Health Professional that is passionate about making a difference? In this position, you would provide clinical care management to best meet the member's specific healthcare needs and to promote quality and cost-effective outcomes. You would oversees a collaborative process with the member and those involved in the member's care to assess, plan, implement, coordinate, monitor and evaluate care as needed.Responsibilities Responsible for essential activities of case management including assessment, planning, implementation, coordination, monitoring and evaluation. Assessment: collection of in-depth information about a member's situation and functioning to identify individual needs. Planning: identification of specific objectives, goals, and actions designed to meet the member's needs as identified in the assessment.Implementation: execution of the specific case management activities that will lead to accomplishing the goals set forth in the plan.Coordination: organization, securing, integrating and modifying resources. Monitoring: gathering sufficient information to determine the plan's effectiveness and the evaluation phase should determine the effectiveness of reaching the desired outcomes. Applies clinical expertise and judgment to ensure compliance with medical policy, medical necessity guidelines, and accepted standards of care. Utilizes evidence-based criteria that incorporates current and validated clinical research findings. Practices within the scope of their license.Consults with physician advisors to ensure clinically appropriate determinations.Serves as a resource to internal and external customers.Collaborates with other departments to resolve claims, quality of care, member or provider issues. Identifies problems or needed changes, recommends resolution, and participates in quality improvement efforts.Responds in writing or by phone to members, providers and regulatory organizations in a professional manner while protecting confidentiality of sensitive documents and issues.Provides consistent and accurate documentation.Plans, organizes and prioritizes assignments to comply with performance standards, corporate goals, and established timelines.Minimum Requirements Knowledge of health insurance industry trends, technology and contractual arrangements.General computer skills (including use of Microsoft Office, Outlook, internet search). 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In keeping with our Cause and vision, we offer comprehensive well-being programs and benefits, which we periodically update to stay current. 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Nurse Practitioner
Boise State University, Boise
About Us: Boise State University is located along the banks of the Boise River and a short stroll from the state capitol. We are committed to an innovative, transformative, and equitable educational environment that supports student success, and advances Idaho and the world.Boise State is building an inclusive community of faculty and staff whose unique skills, cultural contributions, work history, and perspectives create a rich and rewarding academic experience for our students. Applications from individuals of all backgrounds and identities are welcomed.Learn more about Boise State and living in Idaho's Treasure Valley at https://www.boisestate.edu/about/ Job Summary/Basic Function: The Nurse Practitioner is a trained licensed professional who provides medical care to patients who present to the Boise State University Health Center, including specialized procedures and administrative tasks related to the clinical component of the job. Nurse Practitioners at the Health Center are expected to practice within the full scope of primary care medicine as is typical in a college health center environment. The Nurse Practitioner will, at any one time, maintain a patient panel that includes a mixture of acute and chronic stable medical problems, gender specific problems, as well as a panel of stable mental health patients. While areas of clinical interest or specialization may exist, the Nurse Practitioner is expected to maintain a core level of competence in all areas of primary care medicine and to seek continuing education in areas which support the ongoing maintenance of these generalist skills, or in areas that need development. The Nurse Practitioner will see all patients presented within the scope of practice of the Health Center and seek consultation with the physician(s) at the Health Center as needed. This position will be scheduled to work four, 10 hour shifts a week. Level Scope: Recognized master in professional discipline with significant impact and influence on campus policy and program development. Establishes critical strategic and operational goals; develops and implements new products, processes, standards or operational plans to achieve strategies. Regularly leads projects of critical importance to the campus; these projects carry substantial consequences of success or failure. Requires significant influence and communication with executive leadership. Problems faced are frequently complex and multidimensional, requiring broad based consideration of variables that impact multiple areas of the organization. Essential Functions: 95% of the time the Nurse Practitioner will provide quality medical care to patients at the Health Center, as demonstrated by satisfactory physician-conducted chart review, to include: Acute and chronic medical care within the scope of professional and community standards for a Nurse Practitioner (NP). 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Good knowledge of: general primary care medicine at the level of Nurse Practitioner; human behavior and performance; principles and processes for providing customer and personal services. Experience: diagnosing and treating human injuries, diseases, and deformities; psychological research methods; assessing and treating behavioral and affective disorders. Microsoft computer platform operation. Electronic Medical Records. Basic clinical microscopy. Microsoft Office applications: creation of documents, spreadsheets, and presentations. Minimum Qualifications: Advanced Degree and 8 years of professional experience or equivalent relevant experience. Preferred Qualifications: Master of Nursing-Advanced Practice Nursing (Family or Adult Nurse Practitioner). 2 years of experience in the clinical preceptorship of nurse practitioner students. Idaho State Board of Nursing: Licensed as an Advanced Practice Nurse. Board Certification: Board Certified by a recognized accrediting organization. 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Pharmacy Services Technician
Cambia Health, Boise
Pharmacy Services TechnicianLooking for candidates within Idaho, but the right candidate will be eligible for a remote role within our 4-state footprint (WA, ID, OR, and UT).Primary Job PurposeThe Pharmacy Services Technician is a corporate-wide technical support resource for pharmacy benefit, reimbursement, and other drug use issues which do not require clinical judgment. This function assists the Clinical Pharmacy Consultants and Pharmacy Services staff with formulary-related operations and other operational processes which require knowledge and experience with pharmaceuticals.Normally to be proficient in the competencies listed below:Pharmacy Services Technician would have a high school diploma or related certificate and five years of experience as a pharmacy services technician in a retail, hospital, or other licensed pharmacy setting or equivalent combination of education and experience. Pharm tech certificate may be substituted for two years of experience.Responsibilities:Performs all duties as described in this document unless doing so would require clinical judgement. In any situation in which clinical judgment is necessary, the Pharmacy Services Technician will seek assistance from appropriate medical personnel. Appropriate medical personnel will be available for support during normal business hours.Responds to non-clinical pharmacy issues from providers, pharmacy services staff, case managers, preauthorization nurses, ENCC personnel, and government programs personnel and customer service. These pharmacy issues include formulary drug coverage, appeal and reconsideration claim status, and pricing for drug claims.Completes daily formulary operational processes, including tracking, processing, and obtaining appropriate documentation for pharmacy medical exception requests, prior authorization requests, reconsiderations, and appeals. Prepares reconsideration requests for Clinical Pharmacy Consultant review by obtaining and organizing appropriate documentation, including, but not limited to medical chart notes/reports and medication profiles. Communicates (orally and by written documentation) information and determinations to providers and members as necessary.Obtains and organizes drug utilization data, including patient specific and population-based data, in a manner which facilitates clinical review and decisions by Clinical Pharmacist Consultants. Organizing data includes but is not limited to sorting drugs into appropriate therapeutic and generic categories.Assists with auditing and investigations of medication-related claims, cases, and providers to identify misuse of medications, misuse of (Regence HMO Oregon) resources, substance abuse, and erroneous and fraudulent billing practices. Investigates and organizes workflow for claims referred to Pharmacy Services for review and allowable determination (misc. J codes, providers on review, reconsiderations).Supports wellness and disease state management programs for Pharmacy Service and corporately which contribute to NCQA accreditation and ongoing quality improvement.Contributes to and supports the corporation's quality initiatives through process improvement teams and by encouraging team and individual contributions toward the corporation's quality improvement efforts.Minimum Requirements:Knowledge of medical terminology, health care coding systems such as ICD-10, CPT and HCPCS and HIPAA regulations.Knowledge of pharmaceutical products, including orals, injectables, infusion products, and chemotherapy.Knowledge of general office practices and procedures.Demonstrated knowledge of grammar and techniques of business practice.Ability to interact effectively with a variety of health care professionals, including physicians, nurses, pharmacists, and billing staff both internally and externally.Demonstrate maturity, tact, diplomacy, and persuasiveness.Demonstrated ability to perform pharmaceutical pricing calculations.Ability to type 30 words per minute, 60 wpm preferred.Demonstrated ability to operate a variety of standard business machines including calculators, copiers, and faxes.Basic computer programs skills (Word, Excel, etc.).Ability to organize, plan, and prioritize daily workflow and projects within time constraints.Experience with health insurance and/or prescription benefits preferred.Work Environment:Work primarily performed in an in-home environment.May be required to work overtime.The base pay annual salary range for this job is $18.80 - $34.10/hour,depending on candidate's geographic location and experience.The annual incentive payment target for this position is 5%.Base pay is just part of the compensation package at Cambia that is supplemented with an exceptional 401(k) match, bonus opportunity and other benefits. In keeping with our Cause and vision, we offer comprehensive well-being programs and benefits, which we periodically update to stay current. Some highlights:medical, dental, and vision coverage for employees and their eligible family membersannual employer contribution to a health savings account ($1,200 or $2,500 depending on medical coverage, prorated based on hire date)paid time off varying by role and tenure in addition to 10 company holidaysup to a 6% company match on employee 401k contributions, with a potential discretionary contribution based on company performance (no vesting period)up to 12 weeks of paid parental time off (eligible day one of employment if within first 12 months following birth or adoption)one-time furniture and equipment allowance for employees working from homeup to $225 in Amazon gift cards for participating in various well-being activities. for a complete list see our External Total Rewards page.We are an Equal Opportunity and Affirmative Action employer dedicated to workforce diversity and a drug and tobacco-free workplace. All qualified applicants will receive consideration for employment without regard to race, color, national origin, religion, age, sex, sexual orientation, gender identity, disability, protected veteran status or any other status protected by law. A background check is required.If you need accommodation for any part of the application process because of a medical condition or disability, please email [email protected]. Information about how Cambia Health Solutions collects, uses, and discloses information is available in our Privacy Policy. As a health care company, we are committed to the health of our communities and employees during the COVID-19 pandemic. Please review the policy on our Careers site.
Care Coordinator (Bilingual/ Spanish)
Magellan Health Services inc, Boise
Provides care coordination to members with behavioral health conditions identified and assessed as requiring intensive interventions and oversight including multiple, clinical, social and community resources.•Conducts in depth health risk assessment and/or comprehensive needs assessment which includes, but is not limited topsycho-social, physical, medical, behavioral, environmental, and financial parameters.•Communicates and develops the care plan and serves as point of contact to ensure services are rendered appropriately, (i.e.during transition to home care, back up plans, community based services).• Implements, coordinates, and monitors strategies for members and families to improve health and quality of life outcomes.•Develops, documents and implements plan which provides appropriate resources to address social, physical, mental,emotional, spiritual and supportive needs.• Acts as an advocate for member`s care needs by identifying and addressing gaps in care.• Performs ongoing monitoring of the plan of care to evaluate effectiveness.• Measures the effectiveness of interventions as identified in the members care plan.• Assesses and reviews plan of care regularly to identify gaps in care, trends to improve health and quality of life outcomes.• Collects clinical path variance data that indicates potential areas for improvement of case and services provided.• Works with members and the interdisciplinary care plan team to adjust plan of care, when necessary.•Educates providers, supporting staff, members and families regarding care coordination role and health strategies with afocus on member-focused approach to care.• Facilitates a team approach to the coordination and cost effective delivery to quality care and services.•Facilitates a team approach, including the Interdisciplinary Care Plan team, to ensure appropriate interventions, cost effectivedelivery of quality care and services across the continuum.•Collaborates with the interdisciplinary care plan team which may include member, caregivers, member`s legal representative, physician, care providers, and ancillary support services to address care issues, specific member needs and disease processes whether, medical, behavioral, social, community based or long term care services. Utilizes licensed care coordination staff as appropriate for complex cases.• Provides assistance to members with questions and concerns regarding care, providers or delivery system.• Maintains professional relationship with external stakeholders, such as inpatient, outpatient and community resources.• Generates reports in accordance with care coordination goal.Coordinates care of individual clients with application to identified populations using assessment, care planning, implementations, coordination, monitoring and evaluation for cost effective and quality outcomes. Duties are typically performed during face-to-face home visits. Promotes the appropriate use of clinical and financial resources in order to improve the quality of care and member satisfaction. Assists with orientation and mentoring of new team members as appropriate.Provides care coordination to members with behavioral health conditions identified and assessed as requiring intensive interventions and oversight including multiple, clinical, social and community resources.Conducts in depth health risk assessment and/or comprehensive needs assessment which includes, but is not limited to psycho-social, physical, medical, behavioral, environmental, and financial parameters.Communicates and develops the care plan and serves as point of contact to ensure services are rendered appropriately, (i.e. during transition to home care, back up plans, community based services).Implements, coordinates, and monitors strategies for members and families to improve health and quality of life outcomes.Develops, documents and implements plan which provides appropriate resources to address social, physical, mental, emotional, spiritual and supportive needs.Acts as an advocate for member`s care needs by identifying and addressing gaps in care.Performs ongoing monitoring of the plan of care to evaluate effectiveness. Measures the effectiveness of interventions as identified in the members care plan.Assesses and reviews plan of care regularly to identify gaps in care, trends to improve health and quality of life outcomes. Collects clinical path variance data that indicates potential areas for improvement of case and services provided. Works with members and the interdisciplinary care plan team to adjust plan of care, when necessary.Educates providers, supporting staff, members and families regarding care coordination role and health strategies with a focus on member-focused approach to care.Facilitates a team approach to the coordination and cost effective delivery to quality care and services. Facilitates a team approach, including the Interdisciplinary Care Plan team, to ensure appropriate interventions, cost effective delivery of quality care and services across the continuum.Collaborates with the interdisciplinary care plan team which may include member, caregivers, member`s legal representative, physician, care providers, and ancillary support services to address care issues, specific member needs and disease processes whether, medical, behavioral, social, community based or long term care services. Utilizes licensed care coordination staff as appropriate for complex cases.Provides assistance to members with questions and concerns regarding care, providers or delivery system.Maintains professional relationship with external stakeholders, such as inpatient, outpatient and community resources.Generates reports in accordance with care coordination goal.Other Job RequirementsResponsibilities3-5 years experience in Social Work, Nursing, or Healthcare-related field, or relevant experience in lieu of degree., Experience in utilization management, quality assurance, home or facility care, community health, long term care or occupational health required.Experience in analyzing trends based on decision support systems.Business management skills to include, but not limited to, cost/benefit analysis, negotiation, and cost containment.Knowledge of referral coordination to community and private/public resources.Requires detailed knowledge of cost-effective coordination of care in terms of what and how work is to be done as well as why it is done, this level include interpretation of data.Ability to make decisions that require significant analysis and investigation with solutions requiring significant original thinking.Ability to determine appropriate courses of action in more complex situations that may not be addressed by existing policies or protocols.Decisions include such matters as changing in staffing levels, order in which work is done, and application of established procedures.Ability to maintain complete and accurate enrollee records.Effective verbal and written communication skills. Ability to work well with clinicians, hospital officials and service agency contacts.General Job InformationTitleCare Coordinator (Bilingual/ Spanish)Grade22Work Experience - RequiredClinical, QualityWork Experience - PreferredEducation - RequiredGED, High SchoolEducation - PreferredAssociate, Bachelor'sLicense and Certifications - RequiredDL - Driver License, Valid In State - OtherLicense and Certifications - PreferredCCM - Certified Case Manager - Care Mgmt, LCSW - Licensed Clinical Social Worker - Care Mgmt, RN - Registered Nurse, State and/or Compact State Licensure - Care MgmtSalary RangeSalary Minimum:$50,225Salary Maximum:$75,335This information reflects the anticipated base salary range for this position based on current national data. Minimums and maximums may vary based on location. Actual pay will be adjusted based on an individual's skills, experience, education, and other job-related factors permitted by law.This position may be eligible for short-term incentives as well as a comprehensive benefits package. Magellan offers a broad range of health, life, voluntary and other benefits and perks that enhance your physical, mental, emotional and financial wellbeing.Magellan Health, Inc. is proud to be an Equal Opportunity Employer and a Tobacco-free workplace. EOE/M/F/Vet/Disabled.Every employee must understand, comply with and attest to the security responsibilities and security controls unique to their position; and comply with all applicable legal, regulatory, and contractual requirements and internal policies and procedures.
Assistant Professor, School of Nursing
Boise State University, Boise
The School of Nursing at Boise State University invites applications for a Tenure Track (9 month) Assistant Professor position. Tenure Track faculty engage in improving health through research, providing evidence-based education, practice, professional and community service. The successful candidate will have a background in nurse education, competence in a specific clinical practice area, and a defined area of research. Candidates should also be technologically competent and able to use technology to deliver effective education. The ideal start date for this position is August, 2024. This position is location specific to the Boise State University campus and requires teaching in the pre-license BS program. Tenure track faculty generally teach 9 hours of didactic and clinical/lab/simulation courses, or 60% of the allotted workload per semester, with the remaining time devoted toward research and service. About Us: At Boise State University School of Nursing, we prepare nursing students to provide caring, holistic and quality nursing services to diverse populations while also facilitating the development of leadership and interprofessional skills. Our experienced faculty and dedicated staff are focused on academic excellence, high-touch student services, meaningful scholarly pursuits and engagement with our nursing community. In addition to our pre-license program, we offer an online RN-BS, an adult-gerontology nurse practitioner (MS), and a DNP in Leadership. We house an accredited Simulation Center that produces a robust program of research. The School also has multiple long-standing partnerships with local healthcare and community agencies that provide opportunities for innovative scholarship and teaching opportunities. Boise State University is located along the banks of the Boise River and a short stroll from the state capitol. We are committed to an innovative, transformative, and equitable educational environment that supports student success, and advances Idaho and the world. Boise State is building an inclusive community of faculty and staff whose unique skills, cultural contributions, work history, and perspectives create a rich and rewarding academic experience for our students. Applications from individuals of all backgrounds and identities are welcomed. Learn more about faculty careers at Boise State and the City of Boise. Minimum Qualifications: Doctorate required for Tenure track. Appropriate clinical certification (where required). Licensure as a Registered Nurse in Idaho or Nursing compact states; by starting date of employment. Competence in a specific clinical practice area(s). A defined area of research and evidence of scholarly dissemination. Evidence of teaching and/or mentoring experience. Preferred Qualifications: Earned doctorate in Nursing. Recognition in an area of scholarship. Record of external research submissions and/or funding. Research publication record. Teaching and advising experience at undergraduate and/or graduate level. Online, hybrid, and simulation teaching experience. Salary and Benefits: Salary commensurate with experience. Boise State University is committed to offering a benefits package that provides health and financial protection plans as well as resources to promote health and well-being. Our program provides flexibility so you can choose the benefits that are right for you and your family. Application Materials: Please submit all application materials via Boise State Career Site. Be sure to include with your application the following materials: CV/Resume that includes employment history (with dates). Cover letter that describes your interest in and qualifications for the position. Teaching evaluations demonstrating teaching effectiveness, if applicable. Statement about teaching and research philosophy. Contact information for 3 professional references. Position will close for new applicants on May 16, 2024. Applications are being reviewed as received.Advertised: March 27, 2024 Mountain Daylight Time Applications close: May 16, 2024 11:55 PM Mountain Daylight Time
Case Management Manager - DSNP
PacificSource, Boise
Looking for a way to make an impact and help people?Join PacificSource and help our members access quality, affordable care!PacificSource is an equal opportunity employer. All qualified applicants will receive consideration for employment without regard to status as a protected veteran or a qualified individual with a disability, or other protected status, such as race, religion, color, national origin, sex, sexual orientation, gender identity or age.Diversity and Inclusion: PacificSource values the diversity of the people we hire and serve. We are committed to creating a diverse environment and fostering a workplace in which individual differences are appreciated, respected and responded to in ways that fully develop and utilize each person's talents and strengths.Manage the daily operations, including oversight/supervision of the Care Management Team which may include the following: Health Services Representatives (HSR) Member Support Specialists (MSS) and Nurse Case Managers (NCM) and Behavioral Health Clinicians involved in care coordination and case management functions. Key participant in Health Services (HS) strategy, program development and implementation. Integrally involved in, and accountable for, the success of the PacificSource Care Management program development and performance internal measures as well as those established by regulatory entities.Essential Responsibilities:Work closely with the HS Director and other HS Managers to facilitate the development and implementation of new programs and processes to support ongoing success of department goals and initiatives, including but not limited to; ongoing activities related to physical and behavioral health integration and the development of a cohesive team approach to care management.Foster effective teamwork and performance. Manage change and encourage innovation. Build collaborative relationships, encourage involvement and initiative and develop goal orientation in others.Take a leadership role in initiation and implementation of departmental process/performance improvement activities Responsible for process improvement and working with other departments to improve interdepartmental processes. Utilize LEAN methodologies for continuous improvement. Utilize visual boards and frequent huddles to monitor key performance indicators and identify improvement opportunities.Serve as back-up for the Director of Care Management and Utilization Management Manager, as needed.Work collaboratively with the UM Director and Manager Team to develop, implement, and oversee the utilization management process to include; coordination of prior authorization needs for members engaged with care management, as well as the inpatient concurrent review process to ensure medical appropriateness, care coordination needs, and discharge planning for PacificSource patients who have been hospitalized.Develop and oversee the care management process to ensure care coordination and case management needs of PacificSource's are being met and their outcomes are being improved.Ensures consistent workflow and a comprehensive database of patients enrolled in care management and care coordination programs that allows for tracking of case loads, case management program success or failure, and patient and population outcomes.Ensure nurse case managers are providing timely notification of large cases to finance, underwriting, stop loss and other company leaders, as necessary.Serve as key driver and participant to ensure PacificSource care management programs are coordinated with the case management and care coordination functions of our provider and community partners.Responsible for oversight, management, development, implementation, and communication of HS case management and care coordination programs that coordinate and augment community partner programs.Oversee and monitor processes to ensure the protection of personal health information.Facilitate the provision of exceptional customer service to members, providers, employers, agents, and other external and internal customers. Ensure that the delivery of services meet acceptable standards and company and customer expectations.Monitor, evaluate, and report performance relating to volumes, quality, outcomes, accuracy, customer service, and other performance objectives.Serve as a liaison with all PacificSource departments to coordinate optimal provision of service and information.Serve as a resource and participate in development of policies, procedures, and operations.Collaborate and coordinate Health Services department staff between regional offices. At regional offices, represent Health Services by serving on management teams and support marketing and development initiatives towards achievement of PacificSource Health Plans goals specific to the region.Attend continuing education opportunities relevant to case management and care coordination to ensure that PacificSource care management programs maintain current best practices and implement innovative models of care.Maintain frequent and consistent department meetings and one-on-one meetings with individual contributors.Establish and monitor progress towards goals for care management programs, including case loads, outcomes, case timeliness, quality of interventions, training and physician outreach efforts.Encourage and support team members in their pursuit of case management and care coordination certifications.Responsible for hiring, staff development, coaching, performance reviews, corrective actions, and termination of employees. Provide feedback to direct reports, including regular one-on-ones and performance evaluations.Develop annual department budgets. Monitor spending versus the planned budgeted throughout the year and take corrective action where needed.Coordinate business activities by maintaining collaborative partnerships with key departments.Actively participate as a key team member in Manager/Supervisor meetings and HS Management meetings.Actively participate in various strategic and internal committees in order to disseminate information within the organization and represent company philosophy.Ensures ongoing monitoring and adherence to applicable state and federal regulatory and associated compliance requirements.Supporting Responsibilities:Meet department and company performance and attendance expectations.Follow the PacificSource privacy policy and HIPAA laws and regulations concerning confidentiality and security of protected health information.Perform other duties as assigned.SUCCESS PROFILEWork Experience: 5 years clinical experience required. A minimum of 3 years direct health plan experience in case management, utilization management, or disease management, or equivalent preferred. Prior supervisory or management experience required.Education, Certificates, Licenses: Registered Nurse or Licensed Clinical Social Worker or other licensed healthcare or behavioral health care clinician, Oregon licensure required. Certified Case Manager Certification (CCM) as accredited by CCMC (The Commission for Case Management) strongly desired at time of hire. CCM certification required within two years of hire.Knowledge: Thorough knowledge and understanding of medical and behavioral health procedures, diagnoses, and treatment modalities, procedure codes, including ICD-9 & 10, DSM-IV & V, CPT codes, health insurance and State of Oregon mandated benefits. Knowledge of community services, providers, vendors and facilities available to assist members. Strong knowledge of health insurance; including managed care products as well as state mandated benefits. Ability to develop, review and evaluate utilization and care management reports. Experience in adult education preferred. Proficient in the use and implementation of the following tools and concepts across all teams within scope and accountability: Training, Coaching, Strategy Deployment, Daily Operations, Visual Management, Operational Improvement & Team Building/Development.Competencies:Building TrustBuilding a Successful TeamAligning Performance for SuccessBuilding PartnershipsCustomer FocusContinuous ImprovementDecision MakingFacilitating ChangeLeveraging DiversityDriving for ResultsEnvironment: Work inside in a general office setting with ergonomically configured equipment, as needed. Travel is required approximately 20% of the time.Skills:Accountable leadership, Collaboration, Communication, Data-driven & Analytical, Delegation, Listening (active), Situational Leadership, Strategic ThinkingOur ValuesWe live and breathe our values. In fact, our culture is driven by these seven core values which guide us in how we do business:We are committed to doing the right thing.We are one team working toward a common goal.We are each responsible for customer service.We practice open communication at all levels of the company to foster individual, team and company growth.We actively participate in efforts to improve our many communities-internally and externally.We actively work to advance social justice, equity, diversity and inclusion in our workplace, the healthcare system and community.We encourage creativity, innovation, and the pursuit of excellence.Physical Requirements: Stoop and bend. Sit and/or stand for extended periods of time while performing core job functions. Repetitive motions to include typing, sorting and filing. Light lifting and carrying of files and business materials. Ability to read and comprehend both written and spoken English. Communicate clearly and effectively.Disclaimer: This job description indicates the general nature and level of work performed by employees within this position and is subject to change. It is not designed to contain or be interpreted as a comprehensive list of all duties, responsibilities, and qualifications required of employees assigned to this position. Employment remains AT-WILL at all times.
Clinical Services Manager - Boise - (Field Based)
Insulet, Boise
Insulet started in 2000 with an idea and a mission to enable our customers to enjoy simplicity, freedom and healthier lives through the use of our Omnipod product platform. In the last two decades we have improved the lives of hundreds of thousands of patients by using innovative technology that is wearable, waterproof, and lifestyle accommodating.We are looking for highly motivated, performance driven individuals to be a part of our expanding team. We do this by hiring amazing people guided by shared values who exceed customer expectations. Our continued success depends on it!Job Title: Clinical Services ManagerDepartment: Field SalesFLSA Status: ExemptPosition Overview: The Clinical Services Manager (CSM) will work in conjunction with the Territory Manager, Customer Care team and Managed Care team to meet the commercial and clinical needs in their territory for the purpose of increasing referrals and sustaining patients on product.Responsibilities: Promotes the benefits of insulin pump therapy and sells OmniPod Insulin Management System to providers and patients in group and/or individual sessions or as a continuing education offering.Works in conjunction with Sales, Customer Care and Managed Care to achieve sales goals.Assists with sales events such as pump clinics, pump support groups, info sessions, in-the-office educational events, patient info nights, JDRF walks, vendor days, etc.Supports Top Twenty Accounts and existing accounts and record calls in Salesforce.Evaluates and recommends Certified Pod Trainers (CPTs) and Super CPTs who wish to become consultant CPTs for Insulet Corporation.Assigns patient trainings to CPTs or conducts patient training based on business needs of territory, overall costs of training and timeliness of training.Assists with providing regular product demos to patients and HCPs.Oversees CPTs by seeing them face-to-face and by providing timely product updates and by being a clinical resource.Assists with product training for Sales and Clinical hires.Provides Field Feedback to Manager on field-based training of customers and HCPs.Ability to perform administrative duties and turn in on a timely basis.Perform other duties as assigned.Education and Experience:Minimum Requirements:Bachelor's degree and a minimum of 2 years' experience training and/or managing pump patients.Professional up to date credentials and/or certifications are mandatory: i.e. Certified Diabetes Educator (CDCES), Registered Dietitian (RD), or Registered Nurse (RN)State licensure is mandatory as required.Preferred Skills and Competencies:Certified Diabetes Educator (CDCES) is strongly preferred. Prior industry/commercial experience strongly preferred.Professional and polished presentation skills.Strong interpersonal communications, both oral and written.Self-started who needs minimal direction; extremely flexible, with good business acumen.Strong contributing member of the commercial team.Credibility and contacts within the diabetes community.Proficiency with computers. Physical Requirements:Valid driver's license required. Must reside within the geographic area of the assigned area. This position requires regular business travel mostly by car within a set geographic region. Overnight travel and amount of air travel varies by territory, typically 2 - 5 overnights per month.The work environment will be the HCPs offices, clinics, home office and car. Some lifting (up to 30 pounds) may be required when sending or receiving shipments, in handling samples, supplies or literature, and transport of laptop computer.The base pay range for this position is $75,000 - $90,000 annually plus uncapped incentive compensation (based on the achievement of goals). Base pay will vary based on job-related knowledge, skills, and experience. Insulet offers a comprehensive benefits package, generous paid time-off, and career growth opportunities.NOTE: This position requires field-based working arrangements (travel within assigned territory required). #LI-Remote At Insulet Corporation all qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, or status as a protected veteran.( Know Your Rights )
Care Management Nurse - Hybrid
Cambia Health, Boise
Care Management Nurse - Hybrid ID - Independent Doctors of Idaho (IDID)Primary Job Purpose The Care Management Nurse provides clinical care management (such as case management, disease management, and/or care coordination) to best meet the member's specific healthcare needs and to promote quality and cost-effective outcomes. Oversees a collaborative process with the member and those involved in the member's care to assess, plan, implement, coordinate, monitor and evaluate care as needed. General Functions and Outcomes Responsible for essential activities of case management including assessment, planning, implementation, coordination, monitoring and evaluation. Assessment: collection of in-depth information about a member's situation and functioning to identify individual needs. Planning: identification of specific objectives, goals, and actions designed to meet the member's needs as identified in the assessment.Implementation: execution of the specific case management activities that will lead to accomplishing the goals set forth in the plan.Coordination: organization, securing, integrating and modifying resources. Monitoring: gathering sufficient information to determine the plan's effectiveness and the evaluation phase should determine the effectiveness of reaching the desired outcomes. Applies clinical expertise and judgment to ensure compliance with medical policy, medical necessity guidelines, and accepted standards of care. Utilizes evidence-based criteria that incorporates current and validated clinical research findings. Practices within the scope of their license.Consults with physician advisors to ensure clinically appropriate determinations.Serves as a resource to internal and external customers.Collaborates with other departments to resolve claims, quality of care, member or provider issues. Identifies problems or needed changes, recommends resolution, and participates in quality improvement efforts.Responds in writing or by phone to members, providers and regulatory organizations in a professional manner while protecting confidentiality of sensitive documents and issues.Provides consistent and accurate documentation.Plans, organizes and prioritizes assignments to comply with performance standards, corporate goals, and established timelines.Minimum Requirements Knowledge of health insurance industry trends, technology and contractual arrangements.General computer skills (including use of Microsoft Office, Outlook, internet search). Familiarity with health care documentation systems.Strong oral, written and interpersonal communication and customer service skills.Ability to interpret policies and procedures, make decisions, and communicate complex topics effectively.Strong organization and time management skills with the ability to manage workload independently.Ability to think critically and make decision within individual role and responsibility.Normally to be proficient in the competencies listed above Care Management Nurse would have a/an Associate or Bachelor's Degree in Nursing or related field and 3 years of case management, utilization management, disease management, or behavioral health case management experience or equivalent combination of education and experience. Required Licenses, Certifications, Registration, Etc. Must have licensure or certification, in a state or territory of the United States, in a health or human services discipline that allows the professional to conduct an assessment independently as permitted within the scope of practice for the discipline (e.g. medical vs. behavioral health) and at least 3 years (or full time equivalent) of direct clinical careMust have at least one of the following: Certification as a case manager from the URAC-approved list of certifications; or Bachelor's degree (or higher) in a health or human services-related field (psychiatric RN or Master's degree in Behavioral Health preferred for behavioral health care management); or Registered nurse (RN) license (must have a current unrestricted RN license for medical care management)Work Environment Duties performed at home and in Independent Doctors of Idaho - IDIDThe expected hiring range for a Care Management Nurse is $36.00 - $48.60 an hour depending on skills, experience, education, and training; relevant licensure / certifications; and performance history. The bonus target for this position is 10%. The current full salary range for this role is $33.80 - $55.00 an hour. Base pay is just part of the compensation package at Cambia that is supplemented with an exceptional 401(k) match, bonus opportunity and other benefits. In keeping with our Cause and vision, we offer comprehensive well-being programs and benefits, which we periodically update to stay current. Some highlights:medical, dental, and vision coverage for employees and their eligible family membersannual employer contribution to a health savings account ($1,200 or $2,500 depending on medical coverage, prorated based on hire date)paid time off varying by role and tenure in addition to 10 company holidaysup to a 6% company match on employee 401k contributions, with a potential discretionary contribution based on company performance (no vesting period)up to 12 weeks of paid parental time off (eligible day one of employment if within first 12 months following birth or adoption)one-time furniture and equipment allowance for employees working from homeup to $225 in Amazon gift cards for participating in various well-being activities. for a complete list see our External Total Rewards page.We are an Equal Opportunity and Affirmative Action employer dedicated to workforce diversity and a drug and tobacco-free workplace. All qualified applicants will receive consideration for employment without regard to race, color, national origin, religion, age, sex, sexual orientation, gender identity, disability, protected veteran status or any other status protected by law. A background check is required.If you need accommodation for any part of the application process because of a medical condition or disability, please email [email protected]. Information about how Cambia Health Solutions collects, uses, and discloses information is available in our Privacy Policy. As a health care company, we are committed to the health of our communities and employees during the COVID-19 pandemic. Please review the policy on our Careers site.