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
Our website:
HealthCare Partners Base Compensation:
$90,000 - $105,000 annually Bonus Incentive: Eligibility based off organizational performance
Benefits: Fully paid Medical & Dental employee coverage + robust benefits package (PTO, 401k, FSA, Tuition Reimbursement, etc.)
Job Disclaimer: The above job description outlines the general scope and responsibilities of the position. It is not intended to be an exhaustive list of duties, skills, or qualifications required. Responsibilities may evolve based on business needs.
Department: Clinical Services This is a non-management position This is a full time position
