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Spira Care, LLC Care Guide, RN in Shawnee, Kansas

Are you interested in learning about healthcare professions and the latest healthcare innovations in the KC area? Become part of an organization that is dedicated to making a difference in both your career and community.

Job Description Summary:

Spira Care is an advanced primary care healthcare offering in the Kansas City market designed by Blue Cross and Blue Shield of Kansas City. At Spira Care, the experience is designed to provide members with an integrated healthcare experience and to give care professionals a place where they will see the difference they make in people’s lives. Spira Care is looking for professionals who are driven to bring quality, care, and connection along with innovative thinking to a team-based care setting.

On a daily basis, Care Guides will face the challenge of living up to a high standard for our members; having the opportunity to elevate their professional experience with a leadership team driven to inspire progress. Working within Spira Care’s integrated model of care and health insurance, Care Guides will gain new perspectives and appreciation of the role healthcare has in the lives of Spira Care’s Members—because they will actively be improving it. Spira Care teams are made up of professionals who are open and collaborative, always looking for a new way to solve problems so that members can receive an improved care experience. Spira Care is looking to reward professionals who will not just work at Spira Care, but who will embrace its great possibility by creating its future. Care Guides must be obsessive about infusing “care” into “healthcare” by helping our Members utilize Spira Care.

The Care Guide, RN is an integral role within the Care Team who will fulfill key member-experience responsibilities by managing member interactions at Spira Care and assisting members with navigating through the complexities of healthcare to make the experience simple, personal and transparent. They will effectively leverage a myriad of skill sets to provide the member a seamless healthcare experience, blending administrative, educational and care coordination functions. Care Guide RNs will work with members primarily in face to face settings but also on the phone; creating connections and care along the way.

Job Description:

  • Establishes a trusted partnership with the member in both face to face and phone settings; building creditability through knowledge sharing and collaboration around healthcare needs.

  • In collaboration with the Clinical Care Team, monitors effectiveness of plan of care by gathering sufficient information from relevant sources to intervene, as appropriate, to improve health outcomes.

  • Determines appropriate intervals for monitoring plan of care. Utilizes internal, community and other healthcare resources to maximize outcomes. Provides a high degree of customer service in face to face interactions with members primarily; will also taking member incoming phone calls and place outbound calls to member through phone outreach.

  • Operates as the liaison for member healthcare needs and utilizes all forms of communication effectively to maximize a collaborative relationship (including incoming/outgoing phone calls, in-person consultation, written communications such as email, web-based messaging and other relevant communication channels). Must possess the ability to operate successfully in an ambiguous environment that requires a high degree of adaptability, agility and reliability, and autonomy.

  • Manages projects and competing priorities and deadlines to ensure the member receives information in a timely manner. Builds relationships within their own care center and works across care centers to share best practices and foster innovation.

  • Acts as a critical “care team” member and works closely with the providers and staff to support the member/patient. Works with multiple members of the healthcare team to foster continuity and coordination of care.

  • Prioritizes interventions based on the member’s clinical need and readiness to change. Educates and works with members at different educational and health literacy levels in a culturally sensitive manner. Utilizes clinical knowledge and critical thinking skills to individualize plans of care. Assesses the member’s need for education and tailors teaching to the member’s knowledge level and learning style.

  • Maintains confidentiality of all regulated information in compliance with state and federal laws; Reads, understands and follows medical policy and all corporate, divisional and departmental policies and procedures - (including but not limited to: Protected Health Information (PHI), Personal Identifiable Identification (PII)). Meets individual quality performance standards and annual targets for program performance as mutually agreed to by management team to maximize program value. Ensures compliance with applicable URAC and NCQA accreditation guidelines and state and federal regulations.

  • Meets targets for program and individual performance, such as monthly productivity and annual caseload requirements as mutually agreed to by management team to maximize program value. Schedules time effectively. Works with minimal supervision. Handles multiple projects simultaneously. Prioritizes work appropriately.

Minimum Qualifications

  • Associate’s degree in nursing or BSN

  • RN designation licensure in both KS and MO

  • 5 years of Healthcare experience

  • 3 years full-time direct patient care clinical experience in medical/surgical, pediatrics or obstetrics.

  • Intermediate level knowledge of Clinical Guidelines required.

  • American Heart Association BLS Certification required

  • Annual flu immunization required

  • Tetanus shot and TB test records required prior to working in the clinic

  • Ability to work effectively in a fast paced environment with competing priorities.

  • Ability to effectively present information and respond to questions from groups of managers, clients, customers and the general public.

  • Ability to define problems (technical and clinical), collect data, establish facts and draw valid conclusions and action plans.

  • Previous experience in customer service or serving customer in some direct capacity. Phone experience preferable but not required.

  • Advanced Keyboarding Knowledge

  • Intermediate knowledge of Microsoft Windows applications including Word and Excel

  • Ability to work with a variety of member tools/applications used to access and document health and insurance information and support member interactions of various communication channels (phone, in-person, chat, email, etc.)

Preferred Qualifications

  • Bachelor’s degree RN licensure in KS and MO

  • 1 year of utilization review, disease management, and/or case management experience preferred.

  • 3 years of health plan care management or utilization review experience preferred.

  • Thorough knowledge of URAC and NCQA guidelines and state and federal regulations preferred.

  • Thorough understanding of advanced primary care and the Patient Centered Medical Home model.