Registered Nurse (RN) Case Manager | Care Transitions at Abarca Health

Sioux Falls, South Dakota, United States

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$63,340 – $95,160Compensation

Mid-level (3 to 4 years), Senior (5 to 8 years)Experience Level

Full TimeJob Type

UnknownVisa

HealthcareIndustries

Requirements

Registered Nurse (RN) license from Board of Nursing
Ability to work primarily days with rotating weekends and holidays (every 4th weekend/holiday)
Must live within 2 hours of an Avera Facility
Visual acuity adequate to perform position duties
Ability to communicate effectively, hear, understand, and distinguish speech and other sounds
Current knowledge base of disease management protocols, community resources, and documentation requirements

Responsibilities

Manages the care of patients referred to the Care Transitions program, including patient assessment and developing a patient-centered plan of care with follow-up phone calls and home visits
Addresses clinical concerns, provides education, makes referrals to appropriate resources and services, assists with access to care, improves care coordination, and assures an effective discharge plan
Implements the nursing process utilizing proficient assessment skills for admission and follow-up phone calls, including documentation in the electronic medical record
Analyzes assessment data and implements an individualized plan of care with expected outcomes, utilizing resources efficiently for positive outcomes
Manages the plan of care according to patient needs and disease protocols, including coordination and referral to home care agencies
Provides follow-up outbound phone call assessments and ensures appropriate referrals between services upon discharge
Provides clinical management for patients with symptoms and medical concerns, including triage
Makes referrals and collaborates with referral sources, community services, home care, or hospice as identified in the plan of care
Provides education and resources to patients, ensuring access to medications, supplies, home care, follow-up appointments, mental health, and outpatient services
Participates in quality improvement activities and makes recommendations based on clinical expertise
Influences behavior of others to follow recommended care alternatives through instruction and disease management education for patients, families, and caregivers
Educates patients, families, and caregivers on disease processes, community resources, and self-care
Maintains contact with referring facilities, agencies, and community resources

Skills

Registered Nurse

Case Management

Patient Assessment

Care Planning

Care Coordination

Home Visits

Triage

Electronic Medical Record

Discharge Planning

Patient Education

Nursing Process

Abarca Health

Pharmacy Benefit Management services provider

About Abarca Health

Abarca Health provides Pharmacy Benefit Management (PBM) services, focusing on flexible and user-friendly solutions for health plans, employers, and government programs like Medicare and Medicaid. Its main product, the Darwin platform, allows clients to quickly implement and modify benefit designs while ensuring compliance with regulations. Abarca Health manages over $5.3 billion in drug spend and processes 100 million prescription claims annually, offering additional services like home delivery for prescriptions. The company's goal is to deliver exceptional service and innovative solutions in the PBM market.

Aventura, FloridaHeadquarters

2005Year Founded

VENTURE_UNKNOWNCompany Stage

HealthcareIndustries

501-1,000Employees

Benefits

PTO

Parental leave

Work flexibility

Health insurance

Wellness stipend

401k

Tuition reimbursement

Leadership development programs

Risks

Increased competition from Amazon Pharmacy and Mark Cuban's Cost Plus Drug Company.

Growing focus on specialty drugs may require platform adaptation.

Shift towards price transparency could pressure Abarca's pricing models.

Differentiation

Abarca Health's Darwin platform is highly adaptable and user-friendly.

The company offers innovative programs like Triple S en Casa for home delivery.

Abarca Health ensures compliance with ever-changing healthcare regulations.

Upsides

Abarca transitioned two million members to Darwin in 18 months, showing operational efficiency.

Collaboration with Blue Shield of California boosts Abarca's reputation in the PBM sector.

Recognition as a top IT workplace attracts top talent, driving innovation.

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