RN Care Manager
3 weeks ago
As a RN Case Manager at Community Health Systems, Inc., you will play a vital role in providing high-quality care management to our Enhanced Care Management (ECM) members. Under the general supervision of the Nursing Services Manager, you will work effectively with the ECM Provider to deliver effective care management, including outreach and engagement, coordination of care, resource linkages, and seamless transitions of care.
Key Responsibilities:
- Manage a minimum caseload of 40 ECM Members with high risk/complex medical needs.
- Complete medication reconciliation in collaboration with pharmacy/PCP as available for all ECM-enrolled Members.
- Engage Members and support/encourage Member activation towards achievement of health goals via face-to-face or telephone interactions.
- Provide formal and informal training and support for ECM members on medical conditions, including treatments and evidence-base for treatment.
- Represent the ECM Provider as the lead member when necessary.
- Promote a collaborative and effective working environment within the ECM by engaging in evidenced-based communication strategies.
- Track medical and behavioral health outcome measures in the web-based care management platform or equivalent platform.
- Track and assure required assessments and screenings are performed.
- Provide Member and family education about chronic medical and behavioral health conditions to improve health literacy.
- Gather input from other ECM Care Team members to prioritize Member cases for systematic population/caseload review.
- Consult with the ECM Care Team members about clinical concerns or questions, and provide educational training on chronic disease states, prevention, treatment, medications and healthy living.
- Work with Members to identify health/wellness goals, and incorporate these goals into Health Action Plans/Shared Care Plan that facilitate communication among Members and Providers.
- Coordinate physical care management and care coordination relationships with external healthcare Providers.
- Receive, identify and follow-up treatment and medication alerts.
- Ensure smooth transitions of care.
- Review health assessments upon completion by other care team members.
- Model the highest ethical behavior in relationships with co-workers, supervisors, Members, Providers, and colleagues in the community and within the ECM Care Team.
- Assist with the coordination of medical and behavioral health access issues with PCP offices, specialists, and ancillary services.
- Ensure documentation is accurate and in compliance with regulatory requirements and accreditation standards.
- Participate in staff meetings, trainings, committee meetings, or other activities as needed or as directed by CHSI and ECM Health Plan.
- Ensure the privacy and security of PHI (Protected Health Information) as outlined in policies and procedures relating to HIPAA compliance including attending annual compliance training.
Requirements:
- RN unrestricted license required.
- A valid California driver's license, a reliable car, and valid automobile insurance are also required.
- Three (3) or more years of care management experience in a health care delivery setting.
- Experience in a Health Care Organization or experience in Managed Care setting preferred.
- Minimum 1-year clinical experience in an acute care facility, skilled nursing facility, home health or clinic setting preferred.
- American Heart Association BLS certification required.
- Must maintain continuing medical education requirements for licensure.
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