RN Case Manager Team Lead
5 days ago
JOB SUMMARY:
The RN Case Manager Team Lead is primarily responsible for the daily management and support of the Case Management strategies for care coordination for a group of members associated with a Medicare Advantage plan. This position will consult and coordinate with health care team members to assess, plan, implement and evaluate patient care plans.
ESSENTIAL JOB DUTIES:
To perform this job, an individual must accomplish each essential function satisfactorily, with or without a reasonable accommodation.
Hire and assist in training for all new RN Case Managers as indicated
Monitor Health Risk Assessments for members; complete if needed for compliance with model of care
Monitor care plan completion
Provide education based on identified learning needs utilizing available teaching resources to members of the home/facility staff as needed
Monitor and coordinate outpatient discharge planning based on patient needs, clinical circumstances, and benefit coverage
Participate in all managed care related audits
Generate, maintain, and track periodic and annual reports/documents via MS Office program, e-mails to support care coordination program.
Manage all patient transfers within the market
Prepare and conduct weekly case conferences
Track/assist all Part A authorizations
Complete discharge planning for all inpatients and LTACH
Provide updates and records to UM as needed
Reconcile authorizations with UM for accuracy
Oversee authorization education and oversight for specialists and medications
Monitor ICP/ICT coding
Perform quality audits for compliance
Perform improvement projects involving the development of monitoring/collection tools, review of medical records, data entry, analysis, and preparation of audit findings and reports
Participate in patient care conferences, committee meetings, staff development and educational programs to increase or maintain professional competency
Apply medical management criteria accurately
Research clinical questions from employers, members and payers as required
Respond, manage, and resolve day-to-day problems presented in care coordination; communicates effectively with the facility/home
Conducts for 1:1 with RN/CM team
Other duties as assigned
JOB REQUIREMENTS:
Punctuality, reliability
Successful completion of required training
Manage stress appropriately
Handle multiple priorities effectively
Independent discretion/decision making
Make decisions under pressure
Multi-task, meet deadlines, prioritize
Required Computer Software/Equipment used:
Various operating systems
Standard office equipment
Microsoft Suite applications
REQUIRED QUALIFICATIONS:
Education:
o Graduate from an accredited Registered Nursing Program
o Bachelor's degree preferred
Experience:
o Two (2) years' experience in clinical nursing or rehabilitation for the geriatric population
o Two (2) years' experience in managed care required
o 3-5 years' experience performing case management within a managed care environment, preferably with a managed care organization or like facility
License/Certification(s):
o Current state Registered Nursing License
o Current CCM license preferred
o CPR license
o Current and valid driver's license
o Current automobile insurance according to company policy
SUPERVISORY RESPONSIBILITES:
Maintain staff by orienting and training employees
Supervise other RN Case Managers as required
Supervise direct reports to ensure compliance
Occasionally needs manager's direction due to extraordinary circumstances
WORKING CONDITIONS:
Audio-Visual: Good
Hearing: Good
Ability to lift to 40 pounds
Subject to standing, walking, sitting, bending, reaching, kneeling, pushing, pulling; use of hands
Work is typically performed in a standard office environment; well-lit; comfortable temperature-controlled; above-average conversational noise is frequent
Position may require flexible hours, unscheduled overtime or occasional week-end work
Travel may be required
The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
EQUAL OPPORTUNITY EMPLOYER
This Organization is an equal opportunity employer. We do not discriminate based on race, color, religion, sex, handicap, disability, age, marital status, sexual orientation, national origin, veteran status, or any other characteristic(s) protected by federal, state, and local laws. This Organization will make reasonable accommodations for qualified individuals with disabilities should a request for an accommodation be made. A key part of this policy is to provide equal employment opportunity regarding all terms and conditions of employment and in all aspects of a person's relationship with the Organization including recruitment, hiring, promotions, upgrading positions, conditions of employment, compensation, training, benefits, transfers, discipline, and termination of employment.
EducationPreferred- Bachelors or better in Nursing
- Associates or better in Nursing
- Registered Nurse
- CPR Certification
- Driver License
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