Health Case Manager RN - NCL

Overview

The Case Manager will be responsible for applying the six essential activities of case management which include assessment, planning, implementation, coordination, monitoring and evaluation, with the core components focusing on the administration of quality improvement functions such as process, relationships, health care management, community resources and support, service delivery, and psychosocial intervention.

• Registered Nurse (RN) with an active, current, unrestricted license in a Nurse Licensure Compact (NLC) state.
• Bachelor’s degree preferred.
• Case Management Certification (CCM) required; candidates without CCM certification must obtain it within three (3) years of commencing employment.
• Three (3) years of clinical RN experience in a med/surg or ambulatory care setting.
• Clinical experience in at least one of the following areas preferred:
  Behavior Health, Transplant, Neo‑Natal or Oncology.
• Previous experience in managed care a plus.
• Clinical knowledge of the health or social work needs for the population served.
• Ability to identify barriers to a successful care management path.
• Ability to interact effectively with physicians and other members of the health care team.
• Excellent problem‑solving abilities, coupled with solid time management skills.
• Excellent written, verbal and interpersonal communication skills.
• Transferable knowledge, skill and ability to complete job duties independently and proficiently.
• Flexibility in work schedules and assignments.
• Proven examples of displaying Nova’s Core 4:
  Act with Passion, Work Together, Be Accountable, Build Trust.

• Assess the patient’s broad spectrum of immediate and long‑term needs through evaluation of the patient’s social and medical history.
• Develop a plan of care based upon the patient and providers of care clinical assessments, considering physical and psychosocial needs, the benefit plan and cost‑benefit analysis factors which impact the patient’s optimal recovery.
• Continuously evaluate the plan of care within the scope of case management practice based on the changing needs of the patient and monitor the quality of care and effectiveness of care being provided for all involved members of the interdisciplinary team.
• Ensure compliance with regulatory and privacy standards, prompt payment/reimbursement and appeal process as indicated; coordinate the decision and documentation process; maintain a current and accurate database.
• Establish professional working relationships with all members of the interdisciplinary team and communicate case objectives to the appropriate involved parties.
• Act as a patient advocate, understanding and identifying potential complications, and assessing the current and future physical and psychosocial characteristics of illnesses.
• Read, understand and apply principles of the Americans with Disabilities Act and understand federal legislation affecting individuals with disabilities.
• Be knowledgeable of assistive and adaptive equipment.
• Establish available support systems and be versed in researching and interviewing community resources to assist the patient in achieving maximum psychological, social and physical recovery.
• Effectively communicate to the patient the available services and resources applicable to the patient’s immediate and future needs; assist the patient in obtaining these services.
• Identify cases that would benefit from alternative care through assessment and evaluation of the patient’s needs and available resources.
• Work closely with the payer, providers and all involved team members in evaluating the quality and cost effectiveness of services.
• Negotiate cost discounts when appropriate.
• Identify cases that would benefit from alternative levels of care and resources such as rehabilitation facilities and home health care providers.
• Implement alternatives to existing care, considering quality of care and the patient’s current and ongoing needs.
• Understand case management concepts such as roles, philosophies, principles, liability and confidentiality issues.
• Apply these concepts in developing appropriate plans of care and goals based on the needs of the patient.
• Be knowledgeable in…