Nurse, Case Manager
4 days ago
For members of a defined population, the nurse case manager is responsible for coordination of appropriate, cost-effective services that enhance a members quality of life, focus on a members optimal level of independence, and reduces inappropriate utilization of medical services.
Essential Responsibilities:- In close collaboration with the member/members family, and the multidisciplinary Health Care Team (Primary Care Physicians, Specialty Physicians, and other members of the health plan, the network and the community), assesses the members health status, functional limitations, psychological status, social support systems, resources, environmental factors, and response to treatment.
Basic Qualifications: Experience
- Minimum three (3) years of clinical experience of which (2) years of experience in case management are required.
- Required clinical experience must include at least one (1) year in area of specialty as follows:
- Behavioral Health: One (1) year in child, adolescent, adult, and geriatric behavioral health experience is required.
- Geriatric: One (1) year of recent experience with a geriatric and Medicare population is required.
- Pediatric/Adolescent: One (1) year of recent experience with pediatric/adolescent population is required.
- Adult: One (1) year of recent primary care experience with an adult population is required.
- Perinatal: One (1) year of recent labor and delivery of predominately high-risk obstetrics is required.
- Oncology: One (1) year of recent clinical oncology experience is required
- Renal: One (1) year of recent nephrology nursing experience is required.
- Bachelors degree or four (4) years of experience in a directly related field.
- High School diploma or GED required.
- This job requires credentials from multiple states. Credentials from the primary work state are required before hire. Additional Credentials from the secondary work state(s) are required post hire.
- Registered Nurse License (Virginia) within 6 months of hire AND Registered Nurse License (Maryland) within 6 months of hire
- Compact License: Registered Nurse within 6 months of hire
- Registered Nurse License (District of Columbia) within 6 months of hire
- PECOS Enrollment within 3 months of hire
- Case Manager Certificate within 36 months of hire
- Demonstrated competence with medication management is required.
- Demonstrated competence with vascular access management is required.
- Experience with chronic and/or high-risk medical diseases is required, including but not limited to diabetes, CHF, COPD, asthma, Alzheimers, dementia, CVA, cystic fibrosis, cerebral palsy.
- Experience with computer software programs in a Windows environment is preferred.
- Knowledge of regulatory issues for the Mid-Atlantic area is preferred.
- Preferred clinical experience in area of specialty as follows:
- Adult: Perinatal: Four (4) years of labor and delivery experience in a high-risk setting are preferred.
- Renal: Two (2) years of recent dialysis nursing experience are preferred. Hospice certification preferred.
- Masters degree is preferred.
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