Clinical Review RN – VBC, IL
• 14567
- Downers Grove, Illinois
- Nursing
- Regular Full-Time
Job Description
OverviewClinical Review RN- Value Based Care M-F The Clinical Review Nurse works in collaboration with physicians and VBC teams to promote quality outcomes for Medicare patients with complex medical needs. The Clinical Review Nurse is responsible for reviewing complex patient cases, identifying appropriate interventions, and increasing efficient utilization of health care services. In addition, the Clinical Review Nurse will assess and help coordinate resources available to patients to drive improved outcomes. The role will work closely with VBC team members to track follow-up and impact of recommended patient actions. Benefits:
- Comprehensive medical, dental, and vision benefits that include healthcare navigation assistance and medical coverage at 100% (after deductible) when utilizing a Duly provider.
- Employer provided life and disability insurance.
- $5,250 Tuition Reimbursement per year.
- Immediate 401(k) match.
- 40 hours paid volunteer time off.
- A culture committed to Diversity, Equity, and Inclusion (DEI) and Social Impact.
- Up to 12 weeks parental leave at 100% pay and a financial benefit for adoption and surrogacy for non-physician team members once eligibility requirements are met.
Responsibilities
- Review history (e.g., patient charts, claims) of VBC patients with significant utilization and costs.
- Assess each patient and identify opportunities to drive improved outcomes (e.g., connecting to existing VBC programs, organizing coordination of care discussions).
- Coordinate Health Care Services with appropriate physicians and health care providers as needed.
- Manage and provide a comprehensive summary of all patient reviews and recommendations.
- Work closely with VBC Clinical Program Manager to track follow-up and impact of identified patient interventions.
- Identify themes across patient reviews. Work with the VBC Operations teams to develop and implement new care initiatives based on findings.
- Attend continuing education sessions and training relating to your job functions as required.
- Perform additional duties/tasks as assigned.
Qualifications
KNOWLEDGE SKILLS AND ABILITIES:
- Organization: Able to provide order and structure to daily processes and work environment. Demonstrates good organizational skills and ability to prioritize daily work.
- Verbal Communication: Capable of interacting with, and relating to, people of varying educational levels and backgrounds, conveying information clearly and succinctly, applying listening, tact, responsiveness, empathy, and confidentiality. Effective in communicating verbally with other staff and departments related to the job responsibilities.
- Problem Sensitivity: Effective in identifying and analyzing problems.
- Team Work: Must be able to get along with others, work as part of a team, accept constructive criticism, adapt behaviors quickly, and consistently follow and apply work rules. Works effectively with others to accomplish objectives and goals. Willingly offers assistance to others when the need arises. Fosters teamwork and positive rapport within all departments to maximize achievement of goals.
- Computer Proficiency: Must be able to type 40 wpm on a keyboard-typing test required. Proficient in Microsoft Office.
EDUCATION and / or CERTIFICATION/LICENSURE:
- Registered Nurse License in the State of Illinois
- Certification in Case Management, preferred
- Current CPR certification must be maintained (BLS).
EXPERIENCE:
- Case management experience preferred
- Primary Care/Hospital experience
The compensation for this role includes a base pay range of $67,953.60 - $101,930.40, with the actual pay determined by factors such as skills, experience, education, certifications, geographic location, and internal equity. Additional compensation may be available through shift differentials, bonuses, and other incentives. Base pay is only a portion of the total rewards package. Apply Job! Apply to this Job