Clinical Case Management Specialist

2 weeks ago

Glen Burnie, Maryland, United States University of Maryland Medical System Full time
Company Overview

Join the esteemed University of Maryland Medical System, a recognized leader in healthcare excellence. Our institution is proud to be among the few ANCC Pathway to Excellence designated hospitals in Maryland, showcasing our commitment to high-quality patient care. With a dedicated team of over 3,200 employees and 800 physicians, we are equipped with advanced technology and a patient-centered approach to healthcare.

Position Summary

As a Clinical Case Management Specialist, you will work under the guidance of Case Management Leadership to oversee the comprehensive evaluation, planning, implementation, and monitoring of patient care needs. Your role will involve identifying suitable healthcare providers and facilities while ensuring the efficient use of resources to maximize value for both patients and reimbursement sources. You will focus on promoting patient wellness and independence through effective advocacy, communication, and education.

Key Responsibilities

  • Utilize critical thinking and the nursing process to address patient healthcare needs based on evidence-based practices.
  • Analyze criteria and guidelines to monitor patient admissions, readmissions, and high-cost utilizations.
  • Develop population-based management strategies to enhance patient engagement and care quality.
  • Identify patients who may benefit from outreach and initiate care management processes effectively.
  • Collaborate with primary care physicians to ensure efficient and cost-effective medical care for clients.
  • Engage with patients to assess their urgent needs and address their concerns.
  • Establish partnerships with patients to evaluate their healthcare patterns and resource utilization.
  • Advocate for patients and educate them and their families about treatment options and community resources.
  • Facilitate communication among healthcare team members to ensure cohesive service delivery.
  • Document patient interactions and care management activities accurately.
  • Coordinate community resources, ensuring compliance with case management standards and confidentiality regulations.
  • Work with clinical leadership to develop and implement case management protocols.
  • Manage cases based on intensity and acuity, ensuring high-quality patient care delivery.

Qualifications

  • Registered Nurse licensure in Maryland or eligibility through Compact state agreements; BSN preferred.
  • 3 to 5 years of experience in care coordination or outpatient settings.
  • Experience in patient education and goal setting is essential.
  • Preferred: Case Management Certification and familiarity with managed care environments.
  • Knowledge of quality improvement processes and healthcare accreditation standards is advantageous.

Skills and Competencies

  • Strong analytical and organizational skills to enhance case management processes.
  • Proficient documentation and communication skills to maintain accurate patient records.
  • Ability to work effectively under pressure while managing confidential information.
  • Critical thinking skills to resolve issues and improve patient outcomes.
  • Excellent interpersonal skills to engage with patients, families, and healthcare providers.
  • Ability to manage multiple tasks and prioritize effectively in a dynamic environment.

Additional Information

Your information will be kept confidential in accordance with EEO guidelines.

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