Care Manager RN

Newark, NJ | 3 Months

Post Date: 10/17/2017 Job ID: WCG1JP00004197 Industry: Healthcare

Job Function/Family: State\Long-term Care ---- JOB SUMMARY ---- Coordinates the care and services of Long Term Care members across the continuum of illness. Promotes effective utilization and monitors health care resources. Assumes a leadership role within the interdisciplinary team to achieve optimal clinical and resource outcomes. Works with the PCP member?s family Supervisor/Manager of Care Management to assess plan implement coordinate monitor and evaluate services and outcomes to maximize the health of the Member. ---- ESSENTIAL FUNCTIONS ---- Note: The following is not intended to be an exhaustive list of all duties required of this position ---- Key Duties and Responsibilities ---- In conjunction with the PCP member member?s family and other pertinent members of the Interdisciplinary Care Team (IDT) CM completes a comprehensive assessment and develops a Person Centered Service Care Plan utilizing clinical expertise to evaluate the member?s need for alternative services. Assesses short-term and long-term needs and establishes case management objectives.---Manages 75 to 100 active cases based on case intensity and acuity.---Responsible for Utilization Management and uses prescribed criteria to provide timely appropriate and medically necessary service authorizations.---Interacts continuously with member family physician(s) IDT members and other providers utilizing clinical knowledge and expertise to determine medical history and current status. Assesses the options for care including use of benefits and community resources in order to update the Person Centered Service Care Plan.---Acts as liaison and member advocate between the member/family physician and facilities/agencies.---Maintains accurate records of care management activities in the EMMA system using clinical guidelines.---Coordinates community resources with emphasis on medical behavioral and social services. Applies care management standards and maintains HIPAA standards and confidentiality of protected health information. Reports critical incidents and information regarding quality of care issues.---Ensures compliance with all state and federal regulations and guidelines in day-to-day activities.---Participates in monthly chart audits.---Performs special projects as assigned. ---- Additional Position Responsibilities ? Optional ---- ---- MINIMUM QUALIFICATIONS ---- Education ---- State the minimum required for the job ---- Education Level Education Details Required/Preferred ---- A Bachelor's Degree in Health Services Preferred---A Bachelor's Degree in Nursing Preferred ---- Work Experience ---- State the minimum required for the job ---- Experience Level Experience Details Required/Preferred ---- 2+ years of experience in a clinical acute care position(s) preferably in home health physicians office or public health Required---1+ year of experience in care/case management Required ---- Licenses and Certifications ---- List professional licenses and certifications associated with this job ---- Licenses/Certifications Other Licenses/Certifications Required/Preferred ---- Licensed Registered Nurse (RN) Required---Certified Case Manager (CCM) Preferred ---- Skills ---- State the minimum required for the job ---- Skill Sets Other Skills Proficiency ---- Ability to drive multiple projects a plus Intermediate---Ability to multi-task Intermediate---Ability to work in a fast paced environment with changing priorities Intermediate---Ability to work independently Ability to work independently handle multiple assignments and prioritize workload Intermediate---Demonstrated time management and priority setting skills Intermediate---Ability to create review and interpret treatment plans Ability to create review and interpret treatment plans Intermediate---Demonstrated negotiation skills Intermediate---Ability to effectively present information and respond to questions from families members and providers Intermediate---Ability to effectively present information and respond to questions from peers and management Intermediate---Ability to implement process improvements Intermediate ---- Technology ---- List technical skills associated with the job ---- Technology Other Technology Proficiency Required/Preferred ---- Microsoft Excel Intermediate knowledge and skills of MS Office including Excel Word and Outlook Express Intermediate Required---Microsoft Word Intermediate Required---Healthcare Management Systems (Generic) Intermediate Required---Microsoft Outlook Intermediate Required ---- Languages ---- List all that apply ---- Languages Other Languages Required/Preferred ---- Other Bilingual skills Preferred ---- SCOPE ---- Level of Supervision Received: ---- A statement which describes the level of independence for this position. ---- [X] Plans and arranges own work refers only unusual cases to supervisors or others. ---- Level of Supervision Exercised: ---- (Select all that apply) Positions Supervised ---- [X] Individual Contributor 1 [ ] (Please check all that apply) ---- Impact: ---- A statement which describes the impact to the company regarding contributions decisions recommendations or actions taken by the incumbent. ---- [X] Failure to obtain results or erroneous judgments or recommendations would normally have serious results and may require substantial expenditure of resources to correct and / or achieve goals. ---- Problem Complexity: ---- A statement which describes how clearly a problem is defined when presented how much additional effort is required to understand the nature of the problem and the typical timescales for resolution. ---- [X] Provides resolution to a diverse range of recognizable complex problems. Analysis is required to identify root cause. Uses judgment within defined boundaries to develop solutions. ---- PHYSICAL DEMANDS AND WORKING CONDITIONS ---- Physical Demands ---- While performing the duties of this job the associate is required to meet the following physical demands: ---- ---- The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job_ Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. ---- Working Conditions ---- While performing the duties of this job the associate is required to meet the following working conditions: ---- Working Condition None Seldom Occasionally Frequently ---- ---- The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job_ Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. ---- Travel Requirements Typically no but some locations/states may require occasional travel to inpatient bedside


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