RN Case Manager

3 hours ago

Riverside, California, United States SCM Associates Full time
Job Description

The RN Case Manager plays a crucial role in identifying, assessing, planning, coordinating, implementing, monitoring, and evaluating options and services for individuals requiring case management services. This position requires collaboration and communication with clients, families, physicians, and other healthcare team members to provide quality, cost-effective outcomes.

Responsibilities and Duties
  1. Process cases using the outcome management model and tools, or alternate customer-specified models and tools.
  2. Obtain written authorization for case management services and release of information.
  3. Assess clients/families to identify strengths, resources, problems, psychosocial, financial, and medical history, current status, diagnosis, prognosis, functional status, goals, current treatment plan, and needs.
  4. Develop a plan of care through interdisciplinary collaboration, identifying realistic short- and long-term goals.
  5. Identify, secure, and coordinate services and resources to implement the plan.
  6. Monitor services for continued appropriateness and report to TPAs and insurance carriers.
  7. Evaluate client progress, plan, and services provided, with modifications as necessary.
  8. Provide ongoing instruction to clients and families regarding the injury/disease process, treatment options, and present care.
  9. Promote clients'/families' self-advocacy skills to achieve maximum self-sufficiency.
  10. Have knowledge of benefit packages and available funding sources and systems of care, coordinating with payers for authorization of payment.
  11. Provide in-depth reporting of outcomes encompassing clinical, functional, financial, and customer satisfaction areas.
  12. Demonstrate effective, accurate, and timely verbal and written communication in all work situations.
  13. Identify and disclose situations resulting in exposure to legal liability or poor quality care affecting clients.
  14. Frequently travel to patient appointments.
  15. Perform other related duties as assigned in accordance with necessary job functions.
Supervisory Responsibilities

This position has no supervisory responsibilities.

People Contact

This position requires regular interactions within and outside the company to carry out job duties and company policies and procedures, requiring abilities of persuasion and cooperation.

Decision Making

This position requires frequent decision making and the ability to plan and perform unusual or difficult work with general operation methods/procedures.

Supervision Received

This position exercises considerable latitude in determining objectives and approach to assignments, with completed work reviewed from a long-term perspective for desired results by a Manager of Case Management.

Minimum Position Qualifications

To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill, and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

Education and/or Experience:

  1. Registered nurse required.
  2. BSN preferred.
  3. CCM preferred.
  4. Two years of full-time managed care or hospital-based case management experience required.

Language Skills:

  1. Ability to read, analyze, and interpret medical information, professional journals, technical procedures, governmental regulations, and standards of care.
  2. Ability to effectively present information and respond to questions from customers, managers, and clients as appropriate.

Mathematical Skills:

  1. Ability to add, subtract, multiply, and divide in all units of measure, using whole numbers, common fractions, and decimals.
  2. Ability to compute rate, ratio, and percent and to draw and interpret bar graphs.

Reasoning Ability:

  1. Ability to solve practical problems and deal with a variety of concrete variables in situations where only limited standardization exists.
  2. Ability to interpret a variety of instructions furnished in written, oral, diagram, or schedule form.

Computer Skills:

  1. Knowledge of database software, internet software, and Microsoft word processing software.

Certificates, Licenses, Registrations:

  1. RN license in state(s) where cases are to be managed.
  2. Valid driver's license.
  3. Valid automobile liability insurance.

Other Skills and Abilities:

  1. Ability to organize and evaluate workload and prioritize projects.
  2. Ability to meet deadlines.
  3. Ability to complete multiple, simultaneous projects with accuracy and efficiency.
  4. Detail orientation.

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