Clinical Nurse Case Manager

1 week ago


Vestavia Hills, Alabama, United States DirectEmployers Full time

Company :
DirectEmployers

Job Overview :

POSITION SUMMARY:


This role is essential for the development, execution, and assessment of individualized care strategies for patients and their families or caregivers throughout the healthcare continuum.

The incumbent will apply established standards of practice in case management by working collaboratively with healthcare providers, clinical teams, insurance plans, and external stakeholders while advocating for patients and their families to ensure alignment of objectives and care plans.

As a professional role model, the incumbent will leverage their expertise in care management to foster a collaborative work environment that enhances patient outcomes, engages patients and caregivers in their healthcare journey, and promotes efficient resource utilization.

This position plays a vital role in managing readmissions, optimizing length of stay, reducing emergency department usage, and enhancing patient and family satisfaction.

KEY RESPONSIBILITIES:

Participates in or conducts thorough assessments of patients and their families/caregivers, addressing clinical needs, social determinants of health, and financial challenges that may affect their health management.

(20%)

Proactively identifies obstacles and evaluates circumstances for the designated patient group, including risks for admission/readmission, available external resources, and the capacity of patients and families to ensure safe transitions and coordinated care.

(20%)

Facilitates clinical care coordination among the patient, family, healthcare providers, and interdisciplinary team members. (25%)

Advocates for patients and families by effectively communicating with healthcare providers, interdisciplinary team members, payers, and post-acute care partners to guarantee optimal outcomes and care delivery. (15%)

Utilizes knowledge of industry standards to provide relevant education to patients, families, providers, and interdisciplinary team members on topics such as care appropriateness, documentation requirements, utilization review principles, insurance benefits and limitations, transition planning, length of stay, and resource management.

(10%)

Actively pursues professional development opportunities through certification, mentoring, and participation in departmental or organizational committees. (5%)

Complies with the policies, procedures, rules, regulations, and requirements of healthcare facilities and clinical environments. (5%)

QUALIFICATIONS:

Minimum Requirements:

Bachelor's Degree in Nursing
OR
Bachelor's Degree and Nursing Diploma
OR
6 years of relevant experience in lieu of a degree

3 years in a clinical nursing capacity

Current RN licensure in the state of Pennsylvania OR Current multistate licensure through the enhanced Nurse Licensure Compact (eNLC).

Professional Certification within 5 years of employment commencement. Incumbents in this role as of a specified date have until a later date to obtain

Strong critical thinking and problem-solving abilities

Adaptability and flexibility in response to change

Excellent communication and collaboration skills, with the ability to adjust style based on the audience (providers, peers, clinical team members, patients, families)

CPR certification from the American Heart Association

Background clearance certificates as required by law

Preferred Qualifications:
Nationally recognized Case Management Certification

Familiarity with transition planning and knowledge of community and facility resources

Understanding of motivational interviewing techniques

Licenses or Certifications:

Required:
None

Preferred:
ACM Certification (Accredited Case Manager) from the American Case Management Association

Case Management certification from the American Board of Occupational Health Nurses (ABOHN) and Certified Case Manager (CCM) from the Commission for Case Manager Certification (CCMC)

Disclaimer:
  • The job description has been designed to indicate the general nature and essential duties and responsibilities of work performed by employees within this job title. It may not contain a comprehensive inventory of all duties, responsibilities, and qualifications required of employees to do this job.

  • Compliance Requirement:
This position adheres to ethical and legal standards and behavioral expectations as outlined in the code of business conduct and company policies. Employees may have access to confidential information that must be protected at all times. Compliance with the Health Insurance Portability Accountability Act (HIPAA) and all data security guidelines is mandatory. Furthermore, all employees are expected to uphold the company's Code of Business Conduct, which includes adherence to applicable federal and state laws, rules, and regulations as well as company policies and training requirements. DirectEmployers prohibits discrimination against qualified individuals based on their status as protected veterans or individuals with disabilities, and prohibits discrimination against all individuals based on their race, color, age, religion, sex, national origin, sexual orientation/gender identity, or any other category protected by applicable federal, state, or local law.

EEO is The Law

Equal Opportunity Employer Minorities/Women/Protected Veterans/Disabled/Sexual Orientation/Gender Identity

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