Position in this function is responsible for the care management and coordination of all high risk high need patients assigned to a specific site, including both in and out patient clinical care. Assists clinicians in making informed decisions with these patients in order to promote better outcomes and smooth transitions of care. Follows the standards of Case Management and acts as the single point of contact for patients and families and providers. Maintains records and data analysis related to high risk cases to report outcomes and ROI. Works collaboratively with all internal and external partners to ensure better clinical outcomes.
As the Complex RN Case Manager you will be responsible for care management and coordination of care for high risk cardiac and congestive heart failure patients. You would be working in the Cardiology department. You will be working closely with the Cardiology Providers, assisting with the CHF clinic, assisting with remote telemonitoring of patients and assist management/providers to set up other clinics/programs that are of interest. The Complex RN Case Manager will have his/her own scheduled patients who come in for visits as well as those patients who will need to be reached telephonically.
Primary Responsibilities:- Apply case management standards of practice to focus on effective care of high risk high need patients at a specific site
- Serve as a patient advocate and resource and provide critical information and recommendations to the rest of the care team
- Participates in assessment activities to develop individualized plans of care in coordination with patient, family and providers
- Follows patient through various transitions of care to ensure that any gaps are identified and remedied, break down silos and promote efficient health care delivery
- Maintains strong knowledge of UM, Case management, community resources and plan benefits to ensure improved outcomes
- Works collaboratively with primary care on site staff to ensure patient compliance and adherence to medical plan of care
- Assist clinicians in implementing best practices for chronic care and disease management
- Follow standard protocols, processes and policies to include but not limited to the following: Medication Refill, Preventative Services, Managing Conditions, and Disease Case Management as signed by department head or designee
- Care management and coordinating care for our high risk Cardiology and CHF patients
- Knowledge of Milliman criteria and utilizing these criteria to manage CHF patients
- Assist Clinicians in implementing best practices for chronic care and disease management
- Participates in assessment activities to develop individualized plans of care with patients, family and Providers
- Provide patient education on disease processes to help promote self-management and compliance
- Responsible for maintaining an active caseload and provide interventions as needed within area of expertise and within their scope of practice
- Heart Failure disease management (telephonic and/or in person) will focus on adherence to lifestyle changes, symptoms recognition by patients, developing individualized treatment plans with patients and helping patients with the implementation of the treatment plan
- Responsible for ongoing monitoring of patients treatment plans, adherence, if goals are achieved and evaluation of care; Assisting in reducing readmission rates
- Exercise sound judgment (Critical Thinking Skills) in evaluating situations and making decisions; notify appropriate staff/providers in situations requiring assistance
- Make outbound telephone calls to patients to assess members' current health status.
- Provide telephonic nursing support to patients/caregivers related to disease process, signs and symptoms to report, telemonitoring, individual treatment plans, medications and for any additional concerns
- Responsible for monitoring and evaluation of electronic data received in the Telemonitoring Software Application from remote biometric monitors located in the patient's home
- Responsible for telephonic nursing assessment of biometric alerts, mission information and intervention accordingly within their scope of practice
- Maintains monthly statistics generated from current patient case load and telephonic patient case load
- Knowledge of relevant computer systems and software applications (e.g., IDX; MS Word; MS Excel; Outlook; Touchworks) or ability to learn new programs
- Communicates with customers in a manner that is clear, concise and understandable. Utilizes appropriate phone etiquette and effective listening skills when interacting with customers/family
- Maintaining relevant training and certifications related to management of procedures and protocols (e.g., LearnSource; CPR; ACLS)
- Functioning as a resource for other co-workers and new hires, assist to help answer questions and direct them to the needed resources
- Assisting Supervisor and/or Manager with department related projects by completing tasks correctly and efficiently
- Adheres to Internal company/department-specific protocols, procedures, policies and workflows
- May perform other required duties and responsibilities as outlined by the company/department
You'll be rewarded and recognized for your performance in an environment that will challenge you and give you clear direction on what it takes to succeed in your role as well as provide development for other roles you may be interested in.
Required Qualifications:- High School diploma or equivalent
- Registered Nurse with active unrestricted license in the State of Nevada
- Must possess a valid Nevada driver's license and maintain personal auto insurance coverage
- BLS certification or obtain within 30 days of hire
- 3+ years of nursing experience with direct patient care in a Critical Care setting (Critical Care, general ICU, ER)
- Knowledge of UM and plan benefit designs
- Demonstrated ability to perform case management activities
- Demonstrates strong clinical knowledge, ability to perform clinical assessments on Cardiology patients, ability to use critical thinking skills and has the capacity for continued learning
- Proven ability to demonstrate knowledge of and apply those to the job function and responsibilities
- Proven to possess solid verbal and written communication skills including excellent phone etiquette and customer service skills
- Proven competent with MS Office, Excel and other practice management systems or possess the ability to continue to learn new programs
Preferred Qualifications:- Bachelor's degree in healthcare or related field preferred or working towards completion of Bachelor's degree
- CCM certification
- ACLS certification or must be able to complete certification within 30 days of hire
- Experience in Cardiology, Case Management and CCM certification
Working Conditions: Normal clinic environment. Ability to have their own transportation to travel frequently within the Las Vegas Valley. Ability to pass FIT testing and wear protective mask as deemed by SMA in the course of work at clinic. Moderate to heavy phone and computer usage.
Pay is based on several factors including but not limited to local labor markets, education, work experience, certifications, etc. In addition to your salary, we offer benefits such as, a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (all benefits are subject to eligibility requirements). No matter where or when you begin a career with us, you'll find a far-reaching choice of benefits and incentives. The salary for this role will range from $60,200 - $107,400 annually based on full-time employment. We comply with all minimum wage laws as applicable.
