Job Description

The Health Risk Assessment (HRA) Nurse Specialist is responsible for gathering data in order to complete Health Risk Assessment.  Using the HRA tool the HRA Nurse Specialist documents interactions with the member and / or caregiver to identify complex illnesses and / or behavioral conditions that the member may have for enrollment into a specific case, disease, or behavioral health management program.

 

Completion of the Health Risk Assessment.  Identify member needs and make appropriate referrals in case, disease, or behavioral health management program.  Ensure continuity of care throughout the delivery system.  Identify high cost members whose utilization can be reduced through case management.  Identify gaps in care.  Complete member surveys, assessments, and care plans.  Educate members on the importance of good health and following up with the Primary Care Physician on a regular basis.  Educate members on case, disease or behavioral health management programs available.  Attend case management team meetings, as scheduled. 

 

Completion of the Individualized Care Plan on "Low Risk" members.  Works collaboratively with the member in the development of the ICP which incorporates the unique, complex and individual needs of the member.  The ICP is developed from information gathered by conversation with the beneficiary and appropriate providers, comprehensive clinical assessments, risk stratification and targeted answers from the HRA.  The ICP outlines goals which are time sensitive and measurable, and are specific to the identified medical / behavioral care needs of the beneficiary as well as any cultural, ethnic, and / or spiritual beliefs.  Monitor progress toward treatment goals.

 

Coordinates and leads the Interdisciplinary Care Team conference for "Low Risk" members.

 

Health Choice exists to improve the health and well-being of the individuals we serve through our health plans, integrated delivery systems and managed care solutions. We strive to recruit and retain only the finest health care professionals with the highest levels of integrity, compassion and competency. If you are driven by your own personal commitment to these values and desire to work in a team-focused, collaborative and supportive environment - while still being valued for your individual strengths - Health Choice is the place for you.

Equal Opportunity Employer Minorities/Women/Veterans/Disabled



Qualifications

Qualifications:

High School Diploma / GED

Licensed Practical Nurse from an accredited nursing school

Active, current, valid, and unrestricted Arizona state LPN license

At least two (2) years in a health care setting

HMO / Managed Care / Medicare / Medicaid experience

Knowledge of Medicare and Medicaid regulations and guidelines

Knowledge of professional and community based resources helpful

 

Application Instructions

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