RN Complex Case Manager Hybrid-Ohio Counties

2 weeks ago

Bellefontaine, Ohio, United States CNSI Full time
Job Summary

The RN Complex Case Manager will provide in-home, in-person care coordination in defined areas of coal mine states and telephonic care coordination across the United States. An integrated case management model, including care coordination/case management and disease management, assists the Funds team in maintaining beneficiaries at their most optimal functional level.

Key Responsibilities
  • Use independent nursing judgment and discretion to address, resolve, and process problems impeding the diagnostic or treatment progress, including medication set-up, blood pressure checks, pulse, temperature, and weight checks to support the home program.
  • Seek consultation from physicians, specialists, pharmacists, and other disciplines as necessary to facilitate care to optimize beneficiary function or prevent further decline in health.
  • Develop beneficiary-centered care plans demonstrating shared accountability between beneficiaries, caregivers, and providers.
  • Coordinate health and social services, coach the beneficiary and families, advocate for the beneficiary, educate the beneficiary and family, clarify, and assist with physician care plans, and communicate status and plans among the care team and resources, as indicated.
  • Conduct visits in the beneficiary's home. Visits to hospitals, nursing homes, and physicians' offices as necessary to continue the plan of care and support transition.
  • Review the care plan and progress in regular care conferences, emphasize transitions to other programs, and teach self-management/family caregiver management of chronic conditions to optimize functions, improve health, prevent further decline, or remain in the community.
  • Ensure day-to-day processes are conducted in accordance with the Utilization Review Accreditation Commission (URAC) and other regulatory standards.
Requirements
  • Unrestricted, active RN license in Ohio (or compact state license).
  • High School diploma or GED equivalent.
  • 3+ years of clinical experience with 1+ years of case management experience.
  • Must be proficient in Microsoft Office, Internet/Web Navigation, and research.
  • Must be proficient in the use of electronic medical record systems/electronic documentation and navigating multiple computer systems and applications.
  • Maintain competency in basic physiological assessments that do not require a physician order, temperature, pulse, blood pressure, weight, and visual skin assessment.

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