RN Case Manager

DaVita Medical Group in Tacoma, WA

position filled

JOB DESCRIPTION

Case Manager – Registered Nurse

Department: Clinical Operations

Status: Regular Full-Time, FLSA Exempt

Location: Tacoma, WA

Reports to: Director of Clinical Operations

JOB SUMMARY

The Case Manager - Registered Nurse provides ongoing support and expertise through comprehensive assessment, planning, implementation and overall evaluation of individual patient needs.  The goal of this position is to enhance the quality of patient management and satisfaction, to promote continuity of care and cost effectiveness through the integration and functions of case management, utilization review/management and discharge planning.  It is the purpose of the Case Manager to ensure that the psychosocial needs of the patients are met. This position assists patients and their families/significant others in making appropriate choices regarding the use of health care services. Case management services may be provided telephonically, in the provider office or at patient’s home.

ESSENTIAL DUTIES & RESPONSIBILITIES

  • Decreases healthcare costs of enrollees by working collaboratively with the case management team to assist members in managing visits to Primary Care Providers offices, decrease ER Utilization, number of hospitalizations, and number of readmits to hospital, skilled nursing facilities and home health
  • Assesses and prioritizes case referrals to assure health plan requirements for outreach and engagement are within expected time frames
  • Provides patient and family education, support and encouragement, especially to enhance adherence to treatment regimen and follow up care
  • When appropriate, facilitates successful transfer of patients to SSI and other appropriate local, state or federal programs
  • Develops communication protocols with physicians in the network and community so that early notification and intervention by the case management team occurs for patients
  • Keeps current on areas of case management, quality management, utilization management, patient education and preventive health guidelines
  • Assesses reports, data, and other health plan information to identify potential patients in need of case management intervention
  • Provides recommendations and assists in the development of policies and procedures that meet the requirements of NCQA, HEDIS, and State and Federal guidelines
  • Develops and implements patient-centered aftercare plans
  • Acts as liaison and patient advocate with other care providers
  • Integrates, coordinates and advocates for complex mental and physical health care services from a variety of health care providers and settings, within the framework of planned health outcomes
  • Develops and implements health care planning and assessment tools for the care management team based on evidence-based practice guidelines
  • Develops an effective support system within the family and community to manage emergency situations and to provide support and safety for the patient
  • Acts to prevent suicide and homicide in accordance with state licensure requirements
  • Assist patients in the management of illness and treatment, monitoring adherence, and proactively investigating and addressing problems that may contribute to non-adherence with the patient and other members of the multidisciplinary team
  • Presents current inpatient and complex cases before UM/QI Committee when necessary
  • Compiles information from workload and other statistical data to prepare reports that demonstrate health care trends within NPN’s patient population
  • Coordinate with Behavioral Health Case Manager on cases with mental health component, dual manage as necessary

KNOWLEDGE, SKILLS AND ABILITIES

           

  • Able to apply current case management principals to provide proactive and concurrent management of identified populations
  • Able to bring complex cases forward to the Clinical Ops Director for informational and mentoring purposes
  • Knowledge of advanced clinical standards, practices, and procedures for designated patient population
  • Knowledge about Medicare, Medicaid, prepaid health care systems (capitation) as they relate to patient health care needs
  • Understanding and working knowledge of the case management process and guidelines
  • Working knowledge of health care delivery systems                         
  • Demonstrated knowledge of PC applications including MS Office Suite
  • Skill in writing clear, grammatically correct, easy–to-use instructional documentation
  • Ability to identify learning needs, set goals and seek educational opportunities
  • Ability to analyze problems and formulate appropriate plans, solutions and courses of action
  • Knowledge of age specific communication needs with the ability to listen actively and respond to internal and external customers in a timely, competent manner both verbally and nonverbally     
  • Ability to work with frequent interruptions
  • Ability to establish and maintain cooperative working relationships with individuals at all levels of the organization and affiliates
  • Ability to maintain confidentiality of patient and all related entity business matters of the organization and its partners
  • Ability to manage detail and work with accuracy
  • Ability to recognize and act appropriately in situations where patient care needs exceed medical certification
  • Skill in working with a team; ability to collaborate on projects with colleagues
  • Skill in working effectively under deadlines and changing priorities

MINIMUM QUALIFICATIONS

Education: Associates Degree from accredited Nursing program, BSN preferred

Experience: 3 years’ broad based clinical experience

Certification/License:

  • Current unrestricted Nursing license for the State of Washington, Case Management Certificate Preferred, mandatory after two years of employment
  • Current driver’s license

EQUIPMENT USED

Office equipment, computer, personal vehicle

MENTAL & PHYSICAL DEMANDS/WORKING CONDITIONS

  • Mental Effort: Must be able to work effectively as a member of NPN team; work is detailed and complex with multiple competing priorities, deadlines and internal and external customers

  • Physical Requirements: Work is primarily in office environment requiring ability to see and hear and communicate as well as operate personal motor vehicle

  • Working Conditions: Work is performed both in an office setting and at clinic locations; noise level may be moderate or loud on occasion; work may be required outside normal business hours

The job description does not constitute a written or implied contract of employment.  NPN reserves the right to revise or change job duties and responsibilities as the need arises. 


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