Case Manager, RN

Tampa, FL 33634 | 3 Months

Post Date: 02/24/18 Job ID: WCG1JP00004480 Industry: Healthcare


  (title): Supv. Case Mgmt ---- Date Last Revised: 4/13/2015 ---- FLSA Classification:: Exempt ---- Job Function/Family: Health Services\Case Mangement ---- JOB SUMMARY ---- Coordinates the care and services of selected member populations 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 Supervisor / Manager of Case 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 ---- Interacts continuously with member. family. physician(s) and other providers utilizing clinical knowledge and expertise to determine medical history and current status. Assess the options for care including use of benefits and community resources to update the care plan.---Acts as liaison and member advocate between the member/family. physician and facilities/agencies.---Coordinates community resources with emphasis on medical. behavioral and social services. Applies case management standards and maintains HIPAA standards and confidentiality of protected health information. Reports critical incidents and information regarding quality of care issues.---Outreaches to members telephonically and/or in-person and coordinates member's case management services.---In conjunction with the PCP and member. completes a comprehensive assessment and develops a care plan utilizing clinical expertise to evaluate the member's need for alternative services. Assess short-term and long-term needs and establishes case management objectives.---Requests consultation and diagnostic reports from network specialists.---Performs special projects as assigned. ---- Additional Position Responsibilities ? Optional ---- Case load may differ by state and/or location based on contract requirements. membership. plan and/or operational best practice.---Some states and/or locations may require nurses to occasionally travel to facility or inpatient bedside to conduct assessments or face to face visits. ---- MINIMUM QUALIFICATIONS ---- Education ---- State the minimum required for the job ---- Education Level Education Details Required/Preferred ---- A High School or GED Required---A Bachelor's Degree in nursing or related field 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 current case management experience Preferred---2+ years of experience in appropriate experience and qualifications required to assessing members individual needs Preferred---2+ years of experience in physical health. aging and loss. appropriate support services in the community. frequently used medications and their potential side effects. depression. challenging behaviors. Alzheimer's disease and other disease related dementias. behavioral health. and issues related to accessing and using durable medical equipment. as appropriate. Preferred ---- 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---Demonstrated interpersonal/verbal communication 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---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 ---- END OF JOB DESCRIPTION


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