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Clinical - Care Manager II (RN)
3 months ago
Location: Remote - Must reside in Bexar, McAllen, and/or Austin. CM will be conducting
telephonic reviews of assessments. CM will be coordinating care with our members however there is a potential for f2f visits in the future.
Shift:
8am-5pm for scheduled visits, may need to work after 5pm to complete documentation.
No overtime.
Job Description: Position Purpose: Perform care management duties to assess, plan and coordinate all aspects of medical and supporting services across the continuum of care for select members to promote quality, cost effective care.
Education/Experience: Graduate from an Accredited School of Nursing. Bachelor s degree in Nursing preferred. 2+ years of clinical nursing experience in a clinical, acute care, or community setting and 1+ years of case management experience in a managed care setting. Knowledge of utilization management principles and healthcare managed care. Experience with medical decision support tools (i.e. Interqual, NCCN) and government sponsored managed care programs.
Licenses/Certifications: Current state s RN license.
Texas Requirements:
Education/Experience: Graduate from an Accredited School of Nursing. Bachelor s degree in Nursing preferred. 2+ years of clinical nursing or case management experience in a clinical, acute care, managed care or community setting. 2+ years experience working with people with disabilities and vulnerable populations who have chronic or complex conditions in a managed care environment. Experience with medical decision support tools (i.e. Interqual, NCCN) and government sponsored managed care programs. Other state specific requirements may apply.
Job Duties:
" Assess the member's current health status, resource utilization, past and present treatment plan and services, prognosis, short and long term goals, treatment and provider options
" Utilize assessment skills and discretionary judgment to develop plan of care based upon assessment with specific objectives, goals and interventions designed to meet member's needs and promote desired outcomes
" Coordinate services between Primary Care Physician (PCP), specialists, medical providers, and non-medical staff as necessary to meet the complete medical socio economic needs of clients
" Provide patient and provider education
" Facilitate member access to community based services
" Monitor referrals made to community based organizations, medical care and other services to support the members
overall care management plan
" Actively participate in integrated team care management rounds
" Identify related risk management quality concerns and report these scenarios to the appropriate resources.
" Case load will reflect heavier weighting of complex cases than Care Manager I, commensurate with experience
" Enter and maintain assessments, authorizations, and pertinent clinical information into various medical management systems
" Direct care to participating network providers
" Perform duties independently, demonstrating advanced understanding of complex care management principles.
" Participate in case management committees and work on special projects related to case management as needed
Walk me through the day-to-day responsibilities of this the role and a description of the project:
Review/research assigned members
Contact the member the day before to confirm visit and set up telehealth meeting invite
Explain to member that the visit may take anywhere between 2-3 hours
Perform assessment either via telehealth (video AND audio) or in-person (in member s home)
Contact PCP office to confirm diagnosis and report any abnormal findings
Upload the MN signature page within 1 business day for attempts to MD signature to begin
Complete the assessment documentation
Coordinate assessment finding needs ex send referrals for DME items covered under the member s core benefit, initiate non-waiver items/services
Once the MD signature is received assessing RN is to sign the MNLOC (assessment) within 24 hours
Process continues from this point as needed
Describe the performance expectations/metrics for this individual and their team:
Meet contractual requirement for each assessment to be completed within 45 calendar days
In order to meet the contractual requirements of 45 days internal TAT needs to be met
What previous job titles or background work well in this role?
Home health background, RNs accustomed to performing home visits.
Required Skills/Experience:
Previous Hospice, Home Health or Service Coordination experience preferred.
Additional Notes
1.
Basic computer knowledge and accurate typing
1.
ONLY submit candidates who have been FULLY VACCINATED
2.
Flexibility
2.
CM will be reimbursed for mileage
3.
Reliable transportation/ VALID DL (No company car)
3.
CM will need to come in office if additional coaching is needed or performance issues arise
Education Requirement:
Education Preferred:
Software Skills Required:
Have experience with computer charting and know how to navigate all products of Microsoft.
Required Certifications:
Current TX RN license with no stipulations, will have to get RUG certification once hired- reimbursable
Required Testing:
