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Specialty Registered Nurse Case Manager
2 months ago
The Specialty Registered Nurse Case Manager plays a vital role in collaborating with a designated group of healthcare providers to address the unique needs of patients with chronic conditions. The team composition may vary based on the specific chronic illness being managed. Key responsibilities include assessing patient requirements and formulating tailored care management strategies to meet those needs. In partnership with physicians, the nurse implements care plans by facilitating access to health services across various providers and disciplines, monitoring patient care, arranging necessary transportation, and making informed decisions regarding patient transfers when appropriate. The role also involves identifying cost-effective solutions, recommending alternative care levels, and promoting self-management while ensuring all documentation is completed accurately. This position functions as an indirect caregiver and adheres to additional responsibilities as assigned. Collaboration with a multidisciplinary team is essential.
Core Responsibilities:- Assess and identify patient needs, collaborating with Primary Care Physicians, Specialists, and other healthcare professionals to develop comprehensive case management plans.
- Continuously monitor and evaluate the effectiveness of care management strategies, making adjustments as necessary.
- Facilitate an interdisciplinary approach to ensure continuity of care, including utilization management, transfer coordination, discharge planning, and securing necessary authorizations for external services.
- Serve as a clinical liaison with external agencies, including County CCS, non-plan facilities, and third-party administrators.
- Prepare reports, communicate changes in programs to relevant staff, and develop protocols in compliance with state regulations.
- Act as a patient advocate and educator, ensuring patients are informed and empowered to manage their health conditions effectively.
- Create individualized education plans for patients and families focused on self-management, providing targeted education related to specific disease states.
- Develop and update training materials, presenting them to staff, members, and families, while facilitating patients' return to daily activities through appropriate referrals.
- Consult with internal and external healthcare providers regarding ongoing care, treatment, or referrals to support services.
- Coordinate transportation and housing arrangements for patients as needed, ensuring effective communication of clinical and benefit information.
- Participate in data collection and analysis related to clinical outcomes and patient satisfaction, contributing to the development and monitoring of action strategies.
- Interpret regulations, health plan benefits, and policies for members, healthcare providers, and external agencies.
Experience
- Minimum of two (2) years of clinical experience as a Registered Nurse in an acute care or outpatient setting.
- Cancer Program: Two (2) years of clinical experience in Oncology preferred.
- Bachelor's degree or equivalent experience (four years) required.
- Registered Nurse License (California)
- Basic Life Support certification required.
- Proven ability to apply principles and techniques of utilization review, care coordination, and case management.
- Familiarity with regulatory requirements and accreditation standards (TJC, Medicare, Medi-Cal, etc.).
- Strong written and verbal communication, interpersonal, critical thinking, and problem-solving skills.
- Proficiency in computer literacy.
- Cancer Program: OCN certification required within one year of hire.
- Cancer Program: Two (2) years of experience in Ambulatory Oncology.
- Case Management Certification or specialty certification preferred.
- Bachelor's degree in nursing or a related healthcare field preferred.
