RN Case Manager Team Lead

The RN Case Manager is primarily responsible for the daily management and support of the Case Management strategies for care coordination for a group of members who are associated with a Medicare Advantage plan. Visit (in person and/or telephonic) patients to ensure proper nursing care. Interview or correspond with physicians to correct errors or omissions and to investigate questionable claims. Consult and coordinate with health care team members to assess, plan, implement and evaluate patient care plans.

This position requires an individual who is a self-starter and team player, has the ability to manage multiple priorities, work with minimal supervision on assigned projects and activities, and demonstrates excellent communication and presentation skills. This individual must be able to adapt quickly to change and be able to collaborate with multiple teams

JOB SUMMARY:

The Registered Nurse Case Manager is responsible for providing daily management and support regarding case management strategies for care coordination for patients associated with a Medicare Advantage plan.

ESSENTIAL JOB DUTIES:

To perform this job, an individual must accomplish each essential function satisfactorily, with or without a reasonable accommodation.
• Manage assigned patient caseload
• Complete health risk assessments for designated members
• Initiate, reassess and revise plans of care in collaboration with the health care team as appropriate
• Evaluate, coordinate, and plan patient care in collaboration with the interdisciplinary health team
• Provide education to the patient/family and facility staff in accordance with identified needs utilizing available teaching resources as needed
• Coordinate outpatient discharge planning in accordance with patient needs, clinical circumstances and benefit coverage
• Participate in all Managed Care related audits; generate, maintain and track reports and documents to support Care Coordination program
• Perform improvement projects involving development of monitoring/collection tools, review of medical records, data entry, analysis, and preparation of audit findings and reports
• Participate in patient care conferences, committee meetings, staff development and educational programs to maintain professional competency
• Apply medical management criteria correctly
• Research clinical questions from employers, members and payors as required; educate members on health access options
• Respond, manage, and resolve day-to-day issues presented in care coordination; communicate effectively with the facility
• Rounding in patient care delivery areas per market needs.
• Other duties as assigned

JOB REQUIREMENTS:

• Successful completion of required training
• Maintain established work schedule
• Handle multiple priorities effectively
• Independent discretion/decision making
• Reliable transportation
• Current automobile insurance according to company policy
Required Computer Software/Equipment used:
• Standard office equipment
• Microsoft Suite applications
• Desktop, laptop and/or iPad
• Standard medical equipment

EQUAL OPPORTUNITY EMPLOYER

This Organization is an equal opportunity employer. We do not discriminate based on race, color, religion, sex, handicap, disability, age, marital status, sexual orientation, national origin, veteran status, or any other characteristic(s) protected by federal, state, and local laws. This Organization will make reasonable accommodations for qualified individuals with disabilities should a request for an accommodation be made. A key part of this policy is to provide equal employment opportunity regarding all terms and conditions of employment and in all aspects of a person's relationship with the Organization including recruitment, hiring, promotions, upgrading positions, conditions of employment, compensation, training, benefits, transfers, discipline, and termination of employment.