Utilization Review Nurse Salary in Santa Fe, NM

DescriptionHRISTUS ST. VINCENTSanta Fe, New MexicoJob DescriptionPOSITION TITLE:  Patient Care Assistant IIDEPARTMENT: CHRISTUS St. Vincent Clinician Group POSITION SUMMARY: Responsible for greeting patients on the phone and in the clinic in a warm friendly tone.  Registration and interviewing of patients to obtain accurate demographic and financial information while scheduling appointment.  Other responsibilities may include returning messages, scheduling follow up tests, referrals and prior authorizations.  Assists patients, nurses and providers in patient care in the clinic setting.  Performs vital signs, and obtains history of chief complaint for visit. Performs various Point of Care Testing and documents assuring quality control for each test completed.  RequirementsMINIMUM QUALIFICATIONS:EDUCATION:  High School Graduation or GED. Successful completion of an accredited nursing assistant, EMT, or medical assistant program of study.CERTIFICATION/LICENSES:  BLS issued through American Heart Association and Certified Medical Assistant certification required. SKILLS: Outstanding Service Excellence skills to guarantee quality patient care and patient satisfactionKnowledge and skill to obtain vital signs and PHIStrong organizational skills; excellent verbal, written and interpersonal communication skills requiredAbility to work collaboratively with othersAbility to work independently, asserts initiative on performance improvement opportunitiesAbility to navigate through computer software by use of a mouse, keyboard or stylus and windows based software.EXPERIENCE: A minimum of one year of in-patient or medical office experience including direct patient preferred.NATURE OF SUPERVISION:-Responsible to:  Clinic ManagerENVIRONMENT: Requires knowledge of general safety standards to limit exposure to infectious disease.  Daily contact with infectious diseases and body fluids.- Bloodborne pathogens: CPHYSICAL REQUIREMENTS: Bending, stooping, and lifting up to 35 lbs, reaching above head and below knee level. Utilization of proper body mechanics. Long periods of sitting at times.  Keyboard usage with sound ergonomic principles.  Must be flexible in work schedule.ESSENTIAL FUNCTIONS:Greets patients, escorts patient into exam room, and performs vital signs, weight and height, and obtains history of chief complaint for visit. Completes documentation appropriately in patient chart.Reports relevant information requiring immediate attention to nurse or provider.Responsible for stocking supplies in assigned physician's examination rooms.Works within the clinic’s scope of practice.Assists with patient check in and check out as needed.Completes annual and core competencies required for scope of practice.Performs various Point of Care testing procedures and documents completely and legibly assuring quality control for each test completed.Appropriately takes direction from charge individual within the scope of practice during emergency situations.Documents and reports malfunctioning equipment and disturbing incidents that occur in clinic to Manager.Maintains infection control standards by clean-up of specified equipment and areas as assigned; takes out biohazard bags from exam rooms at the end of the clinic day and disposes of waste.Attends and actively participates in staff meetings/activities regularly.Completes annual Health Stream and HIPAA online training modules. Attends classes in safety and infection control, in addition patient care conferences or in-services for new equipment, processes and procedures.Preserves patient personal health information to ensure a true record of the patient’s clinic visit.Demonstrates effective competency of care, comfort and safety related to age of patient.Performs all front desk tasks such as meeting and directing patients, answering the phone, making patient appointments.Accesses Epic and other applicable practice management systems to schedule patients and obtain documentation and other patient data as required to support practice activities and processes.Acts as a resource to office staff. Uses skills and experience to anticipate requirements and guide activities of less experienced staff.CUSTOMER RELATIONS: (Refer to Customer Relations for definition.)Exhibits behaviors and actions that create a high level of patient/customer satisfaction, positive patient/customer relations, and respect for the patient’s/customer’s rights needs, and confidentiality.Demonstrates effective communication and human relations skills, which promote harmony and teamwork.Presents behaviors and actions that maintain the hospital’s credibility, integrity, and positive image.Demonstrates behaviors and actions that support the mission, goals, and operations of the hospital and which contribute to continuous service improvement.Other ResponsibilitiesAssists with special projects as assigned.Accurately interprets and communicates Human Resources Policies and Procedures.Exhibits flexibility, adapting readily to changes in the work environment or work schedule.Maintains a positive attitude, even during periods of stress.Assumes responsibility for professional growth and development.Complies and adheres to all CSV policies.Maintains positive attendance and communicates in advance any absence from work.Adheres to all patient and environmental safety policies and procedures.This position description was developed to enhance the communication of the job and performance expectations between the employee and management and is not intended to create a contract of employment. The specifications, essential functions and other responsibilities will be reviewed on a regular basis and are subject to modifications.   POSITION CLASSIFICATION: Grade: 114     FLSA: Non-exempt : X     Exempt : _____   ***** Required completion following interview*****STATEMENT OF UNDERSTANDINGI have read and understand the above job description. I assert that I am able to perform the essential job functions, meet the physical requirements of this position and satisfy the expectations.

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 CoordinatorGrade22Work 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.

Provides leadership and subject matter expertise in care coordination, clinical program concepts, methods, and activities for unlicensed teams. Builds successful relationships with behavioral health providers, physical health partners, community services and agencies.Manage team members` performance through the review of qualitative and quantitative performance results on a regular and ongoing basis. Provide constructive feedback and set improvement milestones when indicated.Regularly assess the clinical performance of staff via documentation audits, live service observations and other performance management tools.Set clear performance expectations with team and communicate how performance goals are linked to organizational goals and values.Motivate and encourage team members to excel. Create a team environment that contributes to a high degree of employee satisfaction.Monitor individual team member reliability patterns and take corrective steps when indicated. Utilize the workforce management system to monitor schedule adherence and other work habits.Recruit, interview, and select qualified clinical and nonclinical team members, take corrective action for team members who do not meet expectations.Lead the clinical team in monitoring and managing care coordination for those members meeting level II or level III behavioral health needs. Oversee program functions such as timeliness of followup from the Health Reimbursement Agreement (HRA).Completion and timeliness of the comprehensive needs assessment and the development and implementation of the treatment plan, including collaboration and sharing information with providers as needed for joint treatment planning and for transitions in care.Use of reporting to monitor the TAT and completion of duties to meet the contractual requirements.Ensures appropriate clinical supervision and case consultation for clinical staff.Assists, on an as needed basis, in response to peak work periods.Other duties as assigned.Other Job RequirementsResponsibilitiesAssociates level degree in mental health or related field.5 years post degree experience in a behavioral healthcare setting.Ability to function independently and as a team member, analyze specific utilization problems, plan and implement care coordination solutions while maintaining a good rapport and relationship with mental health and substance abuse providers.Considerable skill in interpreting clinical records andtreatment information.Working knowledge Microsoft Office Suite.General Job InformationTitleSupervisor, Care Coordination - Remote Santa Fe, NMGrade24Work Experience - RequiredClinical, SupervisoryWork Experience - PreferredEducation - RequiredA Combination of Education and Work Experience May Be Considered., AssociateEducation - PreferredLicense and Certifications - RequiredLicense and Certifications - PreferredRN - Registered Nurse, State and/or Compact State Licensure - Care MgmtSalary RangeSalary Minimum:$58,440Salary Maximum:$93,500This 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.