Job Information
Spira Care, LLC Care Guide, RN in Kansas City, Kansas
Guided by our core values and commitment to your success, we provide health, financial and lifestyle benefits to ensure a best-in-class employee experience. Some of our offerings include:
Highly competitive total rewards package, including comprehensive medical, dental and vision benefits as well as a 401(k) plan that both the employee and employer contribute
Annual incentive bonus plan based on company achievement of goals
Time away from work including paid holidays, paid time off and volunteer time off
Professional development courses, mentorship opportunities, and tuition reimbursement program
Paid parental leave and adoption leave with adoption financial assistance
Employee discount program
Job Description Summary: Spira Care was designed with our patients at the center of their Care Teams. This collaborative, patient-centered approach to primary care offers patients a one-of-a-kind healthcare experience and offers healthcare professionals an opportunity to really see the impact they can make in their patients’ lives.
Our Care Teams are made up of professionals with diverse backgrounds, experiences, and focus areas who are curious, empathetic, and collaborative. Spira Care is looking to welcome people on our team who are excited about innovating in primary care and are passionate about helping people achieve their health goals.
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 Patient in both face-to-face and phone settings, building creditability through knowledge sharing and collaboration around healthcare needs.
Completes Patient assessments by collecting and analyzing information and developing and implementing individualized care plans with appropriate interventions in a culturally sensitive way. Completes these assessments in the areas of clinical, functional, financial, support system, psychosocial, cognitive and environmental realms.
In collaboration with the Care Team, monitors effectiveness of the care plan by gathering sufficient information from relevant sources to intervene, as appropriate, to improve health outcomes.
Determines appropriate intervals for monitoring care plans. Utilizes internal, community and other healthcare resources to maximize outcomes. Provides a high degree of customer service in both face-to-face and phone interactions with Patients, providers and community organizations.
Acts as liaison between Patients, employers, providers, support systems and Blue Cross Blue Shield of Kansas City. Works with multiple members of the healthcare team to foster continuity and coordination of care. 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 Patients and relevant entities receive information in a timely manner. Builds relationships within their own Care Center and works across other 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 Patient. Works with multiple members of the healthcare team to foster continuity and coordination of care.
Prioritizes interventions based on Patients’ clinical and social needs and readiness to change. Educates and works with Patients 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 Patients’ need for education and tailors teaching to their 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) and Personal Identifiable Identification (PII) and Heath Insurance Portability and Accountability Act (HIPAA)).
Meets individual, team and company quality performance standards and annual targets for program performance as mutually agreed to by leadership to maximize program value; ensures compliance with applicable URAC and NCQA accreditation guidelines and state and federal regulations
Schedules time effectively. Works with minimal supervision; handles multiple projects simultaneously. Prioritizes work appropriately
Presents information and responds to questions from groups of managers, providers, coworkers and Patients
Defines problems (technical and clinical), collects data, establishes facts and draws valid conclusions and action plans
Works with a variety of tools/applications used to access and document health and insurance information and support Patient interactions of various communication channels (phone, in-person, chat, email, etc.)
May be required to travel between Care Centers
Minimum Qualifications
Associate or bachelor’s degree in nursing
Valid and active Registered Nurse (RN) in Kansas and Missouri or multi-state compact license
BLS certification from American Red Cross or American Heart Association.
Maintain licensures and certifications throughout employment.
5 years of healthcare experience
3 years of full-time direct patient care and clinical experience in medical/surgical, pediatrics or obstetrics
Intermediate level knowledge of Clinical Guidelines required
Previous experience in customer service or serving customers in some direct capacity. Phone experience preferable but not required
Advanced keyboarding knowledge
Intermediate knowledge of Microsoft applications including Word, Excel, PowerPoint and OneNote
Spira Care has specific vaccination requirements as a condition of employment. You must be able to comply with this condition of employment with or without reasonable accommodation based on a sincerely held religious belief or a disability.
Preferred Qualifications
Bachelor’s degree in nursing
Case Management Certification
5 years' experience, including at least three years of Care/Case/Disease Management, Health Plan, or Utilization Review experience
Thorough understanding of advanced primary care and the Patient Centered Medical Home (PCMH) / Primary Care First (PCF) model
Understanding of Affordable Care Act and Medicare/CMS
Thorough knowledge of URAC and NCQA guidelines and state and federal regulations
Experience working with Health and Wellness programs or an understanding of wellness principles
Intermediate level knowledge of athena EMR application
Intermediate level knowledge of FACETS UM, CM and claims applications
Intermediate level knowledge of GuidingCare application
Spira Care is an equal opportunity employer. All qualified applicants will receive consideration for employment without regard to, among other things, race, color, religion, sex, sexual orientation, gender identity, national origin, age, status as a protected veteran, or disability.
Spira Care is an advanced primary care practice, an innovative solution to simplifying healthcare designed by Blue Cross and Blue Shield of Kansas City in collaboration with community members. Spira Care has nine Care Centers located throughout the Kansas City area, each of which house integrated Care Teams made up of medical providers, clinical support staff, and non-clinical patient-focused team members.
Spira Care, LCC will extend reasonable accommodations to qualified individuals with disabilities who are otherwise not able to fully utilize electronic and online job application systems. For assistance, please send an email to Recruitingteam@spiracare.com .
EOE/M/F/Vets/Disability Affirmative Action Employer
Equal Opportunity Employer
Know Your Rights: Workplace Discrimination is Illegal (https://www.dol.gov/sites/dolgov/files/OFCCP/regs/compliance/posters/pdf/22-088_EEOC_KnowYourRights.pdf)
E-Verify Participation
Equal Employment Opportunity/Nondiscrimination/Affirmative Action Policies (https://bluekcmemberportal.azureedge.net/pdf/2024/EEO-Policy-2024.pdf)
IER Right to Work
FMLA (https://www.dol.gov/whd/regs/compliance/posters/fmlaen.pdf)
Pay Transparency
Employee Polygraph Protection Act (https://www.dol.gov/whd/regs/compliance/posters/eppac.pdf)
