Clinical - Care Manager II (RN)
2 weeks ago
Location: Remote, with member home/facility visits 80% of the time in the following counties Hutchinson, Potter, Carson, Deaf Smith and Randall
Shift: 8 am to 5 pm, may require after hour visits as per member request
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
Complete in-home assessment which includes:
SAI Core A to Core Q
ISP
EDP
Other forms as applicable: 1500 forms, SBP, EVV
Assessing the member s current health status, resource utilization, past and present treatment plan and services, short- and long-term goals, treatment and provider options.
Follow up on requests for items/services
Speaking to providers
Describe the performance expectations/metrics for this individual and their team:
Complete 6 successful visits per week
Submit assessment within 24 hours of visit
Submit all other documentation within 5 Client
Visits are typically M-F 8-5; however, due to contractual requirements, assessments and documentation do require to be turned in within turnaround times/compliance
Due to pediatric population some visits are 3pm or after, we get request for Saturday visits at times
Visits are completed in the home setting, travel to members home is necessary.
Travelling may be 100 + mile radius.
Preferred counties are:
: Hutchinson, Potter, Carson, Deaf Smith and Randall
Visits may include surrounding counties
Travel time will be taken into consideration and may modify productivity for that week.
Internal/External Groups with which the Candidate will interface:
Assessment team, internal group
Required Skills/Experience:
Preferred Skills/ Experience:
1.
Registered Nurse
1.
Bilingual
2.
Pediatric Experience
2.
Case Management
3.
3.
Education Requirement:
ADN or BSN
Education Preferred:
Bachelor of Science in Nursing
Software Skills Required:
Required Certifications:
Registered Nurse
Required Testing:
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