Job Description:

Overview

The Case Manager is responsible for applying the six essential activities of case management which include assessment, planning, implementation, coordination, monitoring and evaluation with the core components (process, relationships, health care management, community resources and support, service delivery and psychosocial intervention).

Qualifications

• Active, unrestricted, and licensed registered nurse required. Associates degree in health related field required; BSN preferred.




• Case management certification preferred (CCM) Need to obtain case management certification within (3) years.




• Three (3) years of clinical RN experience in a med/surg or ambulatory care setting required. Clinical experience in at least one of the following 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.




• Demonstrated ability to identify barriers to a successful care management path.




• Demonstrated ability to interact effectively with physicians and other members of the health care team.




• Proficient PC and Windows skills required, including MS Office.




• Excellent problem-solving abilities, couple with solid time management skills.




• Excellent written, verbal and interpersonal communication skills.




• Demonstrated transferable knowledge, skill and ability to complete job duties independently and proficiently. Flexibility in work schedules and assignments.




• Ability to assume responsibility and maintain confidentiality.




• Proven examples of displaying the Nova values: Passionate, Caring, Respectful, Trustworthy, Collaborative and Accountable.

Essential Accountabilities

• 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 with the providers of care and patient, 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 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 inter disciplinary team.




• Ensure compliance with regulatory and privacy standards, prompt payment/reimbursement and appeal process as indicated; coordinate the decision and documentation process; maintains 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 for complications, understanding methods for assessing the current and future physical and psychosocial characteristics of illnesses.




• Read, understand and apply principals of the American 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 methods of researching and interviewing community resources to assist the patient in achieving maximum psychological, social and physical recovery.




• Ability to effectively communicate to the patient the available services and resources applicable to the patients immediate and future needs. Assist the patient in obtaining these services.




• Ability to identify cases that would benefit from alternative care through assessment and evaluation of the patient's needs, as well as available resources.




• Work closely with the payor, 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 (i.e. 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, principals, liability and confidentiality issues. Apply these concepts in developing appropriate plan of care and goals based on the needs of the patient.




• Be knowledgeable in applying problem solving techniques to the case management process. Analyze and evaluate outcomes and implement alternative when appropriate.




• Document the patient's plan of care in a timely manner.




• Maintain a professional status within the community through membership in professional organizations and/or participation in continuing education.




• Participate in Nova's training and education committees as assigned and perform all assignments in a professional manner.




• Be knowledgeable, of the scope of practice of their state(s) licensure and practice accordingly.

As an Equal Opportunity / Affirmative Action Employer, Independent Health and its affiliates will not discriminate in its employment practices due to an applicant's race, color, creed, religion, sex (including pregnancy, childbirth or related medical conditions), sexual orientation, gender identity or expression, transgender status, age, national origin, marital status, citizenship, physical and mental disability, criminal record, genetic information, predisposition or carrier status, status with respect to receiving public assistance, domestic violence victim status, a disabled, special, recently separated, active duty wartime, campaign badge, Armed Forces service medal veteran, or any other characteristics protected under applicable law. Click here for additional EEO/AAP or Reasonable Accommodation information.

Current Associates must apply internally via their Career Worklet.