Clinical Case Manager
2 weeks ago
Location: Lanham, MD
Salary: $62,000 - $82,000 per year
We are seeking a highly skilled Clinical Case Manager to join our care management team at Luminis Health. As a key member of our team, you will focus on providing comprehensive care management services to patients across the healthcare continuum.
About the Role:
- You will work under the direction of our clinical director of care management to coordinate patient care and provide support for safe, timely, and effective transitions.
- You will use a collaborative process to identify, assess, plan, implement, and evaluate options and services required to meet an individual's health and health-related needs.
- You will promote the right resources, at the right time, and at the right level of care, engaging and supporting patients who require care management services.
- You will determine, using evidence-based guidelines, the correct initial and ongoing level of care for patients and submit appropriate denial reviews for Medicare, Medicaid, and commercial insurers.
Key Responsibilities:
- You will identify and prioritize patients in need of care management services, using a holistic approach that includes biopsychosocial, functional, cultural, spiritual, and financial factors.
- You will develop and coordinate transition plans for patients transitioning to home with home health, community care coordination programs, Hospice or Palliative care, home infusion, and routine sub-acute and skilled post-acute providers.
- You will maintain clear and concise documentation in each patient record to reflect physical and functional limitations, psychosocial characteristics, educational needs, family/social support systems, financial, economic, and transition needs.
- You will participate in nursing unit and department clinical outcome projects as well as process improvement initiatives of care management.
- You will utilize all risk and predictive analytic tools to mitigate potential barriers or risk, prolonged unnecessary hospitalization, and readmission prevention.
Requirements:
- Bachelor's degree in Nursing (BSN) or Associate Degree in Nursing (ADN) with equivalent experience. BSN must be achieved within 5 years of start date in the role.
- Three years of experience in a clinical setting, ambulatory, or post-acute.
- Care coordination experience preferred.
- At least 1 year of Case Management experience is highly preferred.
- Current licensure as a registered nurse by the Maryland Board of Nursing.
- Adherence to the credentialing requirements of AAMC as stated in the nursing bylaws.
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