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Specialty Case Management Registered Nurse
2 months ago
The Specialty Case Management Registered Nurse collaborates with a designated group of healthcare providers to address the unique needs of patients with chronic conditions. The team composition varies based on the specific chronic illness. Responsibilities encompass assessing patient requirements and formulating tailored care management strategies to meet those needs. In partnership with physicians, the RN executes the care plan by facilitating access to healthcare services across various providers and disciplines, overseeing patient care, arranging transportation when necessary, identifying cost-effective solutions, and recommending alternative care levels and resource utilization. This role promotes self-management among patients and ensures all necessary documentation is completed. The RN functions as an indirect caregiver and adheres to additional responsibilities as assigned. Collaboration with a multidisciplinary team is essential.
Key Responsibilities:- Assess and identify patient needs, working closely with Primary Care Physicians, Specialists, and other disciplines to create effective case management plans.
- Monitor and assess the success of case management strategies, making adjustments as required.
- Facilitate a coordinated approach to ensure continuity of care, including managing utilization, coordinating transfers, discharge planning, and securing necessary authorizations for external services.
- Serve as a clinical liaison with external agencies, including County CCS, non-network facilities, external providers, employers, and third-party administrators.
- Compile reports, communicate changes in programs to relevant staff, and develop protocols in line with state regulations.
- Act as an advocate and educator for patients, ensuring they are informed about their conditions and empowered to engage in their care plans.
- Create personalized education plans for patients and families, focusing on self-management and providing specific education related to their health conditions.
- Develop and refresh training materials, presenting them to staff, members, and families. Assist patients in resuming daily activities by providing appropriate referrals for ongoing care.
- Consult with internal and external healthcare professionals regarding ongoing care, treatment, hospitalization, or referrals to support services.
- May assist in arranging transportation and housing for patients, coordinating the transmission of clinical and benefit information to patients, families, and external agencies.
- Engage in data collection and analysis related to clinical outcomes and patient satisfaction. Participate in developing and monitoring action strategies to enhance care outcomes and customer service. Ensure meticulous record-keeping of patient care.
- Interpret regulations, health plan benefits, policies, and procedures for members, healthcare providers, and external agencies.
Experience
- At least two (2) years of clinical experience as a Registered Nurse in an acute care or outpatient setting is required.
- Bachelor's degree or equivalent experience (four (4) years) is required.
- Registered Nurse License (California)
- Basic Life Support certification
- Proven ability to apply general and specialized principles and practices in utilization review, care coordination, transfer coordination, discharge planning, or 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 are essential.
- Proficiency in computer skills is required.
- Bilingual (English/Spanish) Level II is required.
- Certification in Case Management or a specialty area is preferred.
- Bachelor's degree in nursing or a healthcare-related field is preferred.
- Experience in complex case management, Medicare, and Medi-Cal is preferred.
- Must have successfully passed or be active in the bilingual test (within the last 12 months).
- This position will support the Special Needs Program and may also assist with Geriatrics and Palliative Care as needed.
- Weekend workdays are required.
