Case Manager, Health Plan
Company: Sanford Health
Location: Fargo
Posted on: February 4, 2025
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Job Description:
Careers With Purpose Sanford Health is one of the largest and
fastest-growing not-for-profit health systems in the United States.
We're proud to offer many development and advancement opportunities
to our nearly 50,000 members of the Sanford Family who are
dedicated to the work of health and healing across our broad
footprint. Facility: Fargo Health Plan Location: Fargo, ND Address:
th St S, Fargo, ND 58103, USA Shift: 8 Hours - Day Shifts Job
Schedule: Full time Weekly Hours: 40.00 Salary Range: $29.00 -
$46.50 Department Details Registered Nurse Case Manager position on
the Care Transitions team. Core hours M-F, 8 to 5, No weekends or
holidays. Work with members to improve and better manage their
health through education, goal setting and coordination of care.
Job Summary The case manager provides case management and care
coordination for designated Health Plan members. Develops a care
plan that includes managing and directing members to appropriate
resources, services and programs. Evaluates for comprehensive
coordination of care and health services to manage members across
the continuum, creates action plans for members and helps them
track toward program graduation. Collaborates with the integrated
team and partners in order to provide a seamless exchange of
information between providers, members and caregivers with the
ultimate outcome to improve quality, reduce costs and enhance the
member experience. Conducts member assessments, identifies gaps and
interventions, and coordinates ongoing care with physician and
integrated team. Coordinate with facilities to assist with
discharge planning, aftercare follow-up appointments and transition
of care as appropriate. Coordinates and manages medical/behavioral
health needs of members across the continuum of care. May perform
authorizations for services as indicated for specialty case
management. Provides educational resources to member based on
medical and behavioral health needs. Serve as a consult on cases
for their clinical expertise when they are not the lead case
manager. Supports a successful self-management of their long-term
health status. Uses internal and external resources to provide
quality and cost-efficiency care. Utilizes motivational techniques
to promote member engagement. Possesses strong clinical knowledge
and skills. Collaborates with team members both internally and
externally to ensure care is coordinated and appropriate based on
evidence based medicine. Must be self-motivated with the ability to
work independently, a problem solver and fiscally responsible.
Ability to work independently or as a member of a team. Ability to
multitask and work with little direction. Works primarily day
hours. Works primarily telephonically in an office environment and
onsite as needed. Travel may be required as necessary.
Qualifications Depending on area of focus, education, experience
and licensure differs. Bachelor's degree in nursing required.
Graduate from a nationally accredited nursing program preferred,
including, but not limited to, Commission on Collegiate Nursing
Education (CCNE). Accreditation Commission for Education in Nursing
(ACEN), and National League for Nursing Commission for Nursing
Education Accreditation (NLN CNEA) is strongly preferred. OR
Master's degree in counseling, social work, marriage and family
therapy or psychology required. Graduate from a nationally
accredited behavioral health program. Accreditation from (CACREP)
Council for Accreditation of Counseling and Related Educational
programs. Accreditation from (COAMFTE) Commission on Accreditation
for Marriage and Family Therapy Education, or (CSWE) Council of
Social Worker Education. Nursing: Will consider applicant with
significant background in case management, transplant services
and/or other utilization review experience. Minimum of three years
nursing experience is required. Behavioral Health: Will consider
applicant with significant background in case management or
specialized clinical experience. Minimum of five years behavioral
health experience is required. Must have knowledge of Diagnostic
and Statistical Manual of Mental Disorders (DSM) V, and American
Society of Addiction Medicine (ASAM) criteria. Nursing: Currently
licensed with the applicable state nursing board and/or possess
multistate licensure privileges as required by position. Current
Commission for Case Manager Certification (CCMC) is preferred or is
to be obtained within two years of employment. Behavioral Health:
Currently licensed with the applicable behavioral health board or
appropriate regulatory board and/or possess multistate licensure
privileges as required by position. Benefits Sanford Health offers
an attractive benefits package for qualifying full-time and
part-time employees. Depending on eligibility, a variety of
benefits include health insurance, dental insurance, vision
insurance, life insurance, a 401(k) retirement plan, work/life
balance benefits, and a generous time off package to maintain a
healthy home-work balance. For more information about Total
Rewards, visit . Sanford is an EEO/AA Employer M/F/Disability/Vet.
If you are an individual with a disability and would like to
request an accommodation for help with your online application,
please call 1- or send an email to . Sanford Health has a Drug Free
Workplace Policy. An accepted offer will require a drug screen and
pre-employment background screening as a condition of employment.
Req Number: R- Job Function: Health Plan Featured: No
Keywords: Sanford Health, Fargo , Case Manager, Health Plan, Executive , Fargo, North Dakota
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