RN Panel Manager Center of Excellence

Presbyterian is seeking a Nurse Panel Manager - Center of Excellence

The Dual Special Needs Population (DSNP) Center of Excellence (COE) Nurse Panel Manager is a licensed registered nurse (RN) who serves as a central clinical leader responsible for managing an assigned panel of members within the DSNP Center of Excellence at Presbyterian Health Plan. This role is responsible for proactive panel management of members with complex chronic healthcare needs with a focus on coordination of care early identification of risk and deployment of evidence-based interventions. The Nurse Panel Manager collaborates across a multidisciplinary team (care coordination primary care providers specialists pharmacy behavioral health disease management) to optimize health outcomes reduce avoidable utilization and enhance member experience. This role ensures the delivery of holistic person-centered care by proactively identifying high-risk individuals through population health strategies and addressing the complex medical behavioral and social needs of each member.

Working in close collaboration with non-clinical care coordinators and an interdisciplinary team the Nurse Panel Manager develops implements and monitors individualized care plans facilitates transitions of care and drives closure of quality and care gaps. The position ensures compliance with CMS Stars and regulatory requirements while serving as a clinical advocate for members. By combining clinical expertise with population health principles the Nurse Panel Manager plays a critical role in advancing high-quality equitable care for vulnerable populations and supporting the Center of Excellences mission to improve outcomes and enhance the member experience.

• This is a Full Time position - Exempt: Yes
• Job is based at Rev Hugh Cooper Admin Center
• Work hours: Days

• Bachelor of Science in Nursing - BSN required Masters degree preferred.
• Active NM RN license required.
• 6 years of relevant clinical case management and/or patient care experience required.
• DSNP Medicare/Medicaid or complex care population experience required.
• Care Coordination/Case Management experience required
• Strong knowledge of chronic disease management behavioral health integration and social determinants of health required.
• Certified Case Manager preferred.
• Familiarity with HEDIS Stars and CMS quality requirements preferred.
• Managed Care Organization (MCO) and clinical quality experience preferred.

• Oversee an assigned panel of DSNP members applying population health principles to identify and prioritize outreach.
  *Conduct ongoing panel reviews to track care gaps utilization patterns and compliance with clinical practice guidelines.
• Coordinate services across primary care specialty care behavioral health pharmacy and community resources.
• Conduct telephonic and/or in-person outreach to assess health status functional needs social determinants and barriers to care.
• Oversee and revise individualized care plans in partnership with an interdisciplinary care team to assess outcomes and evaluate effectiveness.
• Support transitions of care to reduce preventable hospitalizations and emergency department use.
• Monitor adherence to evidence-based clinical guidelines.
• Perform medication reconciliations and reviews as needed.
• Provide oversight of care coordination to members with chronic or complex conditions which require intensive interventions and multiple clinical social and community resources.
• Assist in implementing coordinating and monitoring strategies for members and families to improve health and quality of life outcomes.
• Train and mentor team members as appropriate.
• Generate reports in accordance with care coordination goals.
• Inform/educate providers and staff about care coordination roles and member-centered health strategies.
• Maintain professional relationships with external stakeholders such as inpatient outpatient and community providers and resources.
• Perform other functions as required.
  
  

About Presbyterian Healthcare Services
Presbyterian offers a comprehensive benefits package to eligible employees including medical dental vision disability coverage life insurance and optional voluntary benefits.

The Employee Wellness Rewards Program encourages staff to engage in health-enhancing activities - like challenges webinars and screenings - with opportunities to earn gift to earn gift cards and other incentives.

As a mission-driven organization Presbyterian is deeply committed to improving community health across New Mexico through initiatives like growers markets and local partnerships. Founded in 1908 Presbyterian is a locally owned not-for-profit healthcare system with nine hospitals a statewide health plan and a growing multi-specialty medical group. With nearly 14000 employees it is the largest private employer in the state serving over 580000 health plan members through Medicare Advantage Medicaid and Commercial plans.

AA/EOE/VET/DISABLED. PHS is a drug-free and tobacco-free employer with smoke free campuses.