RN Field Case Manager
4 days ago
- Establishes and maintains communication and a trusting collaborative relationship with the ICT, member/RP and primary caregiver staff in the ALC and APC
- Communicates with multiple organizations operational units for seamless coordination of benefits, i.e., utilization review staff, provider relations liaison, pharmacy, etc.
- Reviews member's status and assists to achieve progress toward goals; adjusts the ICP as necessary
- Performs administrative functions for or on behalf of the PCP and/or APC
- Participates in program effectiveness analysis and planning
- Performs member visits and rounding as established and directed by the APC
- Communicates status of member with APC for evaluation and ICP updates
- Communicates with member, family/RP, primary caregivers of the community and other members of the ICT with each member visit
- Assists with other clinical and quality responsibilities for member, e.g., gaps in care
- Attends meetings on behalf of the APC and communicates updates to the ICP with the ICT
- Provides clinical educational programs for facility staff
- Communicates information on behalf of the APC to the member, family/RP and primary caregiver staff at the ALC
- Coordinates and collaborates with the health plan/client
- Assists with ACP
- Performs collection of data including functional status, BMI, vital signs, urine test for proteinuria, IFOBT specimen collection, and other clinical data. Results are entered into EMR and reviewed by APC
- Performs care coordination activities within the ALC to ensure member needs are met. (i.e., member external provider appointments, therapy needs, durable medical equipment (DME) and transportation)
- Stays abreast of all Model of Care (MOC) , documentation and policy updates communicated email, newsletters and team meetings
- Maintains an understanding of and utilizes clinical resources independently including but not limited to Resource1, iCoreCodeGenius, Sparq, Learnsource and other Optum internal sites.
- Maintains confidential health information according to state and federal regulations including HIPAA
- Current unrestricted Registered Nurse license in Ohio
- 3+ years of RN experience
- 1+ years of case management experience
- Valid driver's license and the ability to travel locally 75% of the time
- BSN
- Experience with using an electronic medical records
- Experience working in post- acute care, such as long term care or hospice and/or Case Management experience as an RN
- Experience working with the geriatric population
- Basic Microsoft Office skills with the ability to navigate in a Window's environment
- Familiarity with the long term care business environment
- Proven excellent communication and customer service skills
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