Position Summary : The role of the Nurse Case Manager is to engage members enrolled in case management to provide care coordination, education and a plan of care leading to improve health outcomes.
Essential Position Functions/Responsibilities:
- Responsible for telephonic case management, planning, implementing and coordinating all case management activities with members to evaluate the medical needs of the member to facilitate the member's overall wellness.
- Develop a plan of care and course of action to address all issues and barriers
- Provide care coordination for patients including chronic disease management/education and interdisciplinary collaboration while complying with policy and procedures and contractual and regulatory requirements
- Develop and implement case management plans in collaboration with member, caregiver, physician and/or other appropriate healthcare professionals and member's support network to address the member needs and goals.
- Establish appropriate timeframe and frequency for follow-up, case closure, or referral for services as the member transitions through the continuum
- Performs on-going monitoring of the care plan to evaluate effectiveness, document interventions and goal achievement, and suggest changed accordingly
- Follow evidence based guidelines and contact standards to facilitate closure of gaps in care and encourage use of in network services.
- Applies clinical judgment to identify precipitating cause of admission to prevent hospital readmissions
- Oversees all transition of care events to ensure continuity of care
- Delegates and oversees Priority Care Coordinator activity
- Consistent application and/or interpretation of evidence based criteria and clinical guidelines, standardized care management plans, policies, procedures, and regulatory standards while assessing benefits and/or members needs
- Assess for barriers to care, provides care coordination and assistance to member to address concerns
- Presents cases at interdisciplinary rounds to obtain a multidisciplinary perspective and recommendations to achieve optimal outcomes
- Demonstrated accountability and skills in analysis, problem solving, decision making, time management, and oral and written communications
- Facilitates interdisciplinary care team meetings and informal ICT collaboration
- Displays professionalism through good work habits as observed in all encounters
- Uses motivational interviewing to educate, support, and motivate change during member contact
- Keeps current with all standards, policies and procedures of HealthCare Partners and acts as a resource to other staff members with necessary
- Reviews completed HRAs and Medication Reconciliations to determine need and preliminary stratification level for case management
- Other related duties as required
Qualification Requirements:
Skills, Knowledge, Abilities
- Versed in use and application of MCG Guidelines
- Knowledge of NCQA, Federal, State and other Regulatory requirements
- Excellent verbal and written communication skills, expressing self in a clear, concise, and professional manner
- Ability to work collaboratively and effectively with the interdisciplinary team members, patients, families, and external case managers
- Skilled in managing competing priorities and deadlines while demonstrating the ability to effectively prioritize and manage multiple tasks
- Excellent time management and organizational skills
Training/Education:
- NYS RN license required
- BSN preferred
Experience:
- Previous experience in UM and case management/care coordination
- Experience with patient/family education
- Minimum of 2-5 years healthcare experience in an acute setting
Base Compensation; $90,000 - $105,000 annually
Department: Clinical Services
This is a non-management position
This is a full time position
