Care Management RN / Case Management NurseApply Job ID 12673 Date posted Mar. 12, 2019 Location Sussex, Wisconsin Full Time / Part Time Full time (FT)
GENERAL PURPOSE OF JOB
The Care Management RN provides services through telephonic/email contact with patients/family and maintains relationships with pertinent medical providers, insurance vendors, allied health providers, appropriate community resources, and key contacts from the employer’s benefits team. He/she is responsible for completing all steps of the nursing process including providing education and support regarding self-management skills needed to optimize health.
The Care Management RN will navigate complex care and maximize nursing expertise to improve the patient’s care experience. This includes providing options and services to meet each patient’s individual health needs and maximizing available resources to promote quality, cost-effective outcomes. He/she will track and maintain accurate documentation of claim review results and every encounter with the patient, highlighting specific needs identified and addressed.
- Identify rising-risk and high-risk patients through an assessment of claims data for all patients who would benefit from outreach which requires working with variety of patient ages and conditions/diagnoses
- Complete a thorough assessment for participating patients and use motivational interviewing to create a unique patient-focused care plan based on individualized goals and priorities for improved health
- Intervene based on care plan goals including:
- Educating and empowering patients on self-management of acute and chronic health care needs
- Facilitating communication and care among patient/family, resources and the multidisciplinary team
- Collaborating with external partners (payers/third party administrators etc.) and members of the multidisciplinary teams both inside and outside of the Health Center
- Maximizing employer and community resources
- Assisting in problem solving with providers, claims or service issues
- Evaluate response to and effectiveness of nursing clinical interventions, thinking creatively to obtain the best outcome in order to address the patient’s unique needs
- Documents assessment data, education provided, clinical interventions and plan including recommendations and goals for each participant in the electronic medical record. Utilizes best practice documentation guidelines.
- Practices within legal and personal scope of practice
- Provides telephonic transition of care assistance to patients discharged from hospitals or surgery centers
Understand key business drivers and utilize that knowledge to maximize the impact care management has for patients and employers
Distributes program marketing and referral information to key departments that will support Care Management department
Provide recommendations and assist in the development of program goals and objectives for the future.
Appropriate education and/or experience may be substituted on an equivalent basis
- Requires a registered nurse degree from an accredited college or university, BSN required. Current and valid RN license for assigned location(s) of care.
Minimum three (3) years full time nursing experience in acute care or equivalent
Minimum two (2) years full time nursing experience or equivalent in case management required; experience in disease management a plus
Coaching/motivational interviewing experience a plus
Certificates, Licenses, Registration:
Requires a current and valid license in the state(s) of the position
Knowledge, Skills & Abilities:
- Thorough understanding of insurance reimbursement processes including reimbursement types, funding systems and utilization review and management concepts
- Strong critical thinking skills with ability to expertly perform all steps of the nursing process; able to anticipate and independently determine appropriate course of action in more complex situations
- Interpret, evaluate and act on clinical/claims data; previous experience with data collection systems preferred
- Maintain confidentiality of all medical, financial and legal information
- Perform duties in accordance with the Nursing Code of Ethics and other guiding principles of nursing
- Strong team player with ability to be a self-starter professional who can work independently and proactively toward program improvement
- Prioritize and manage multiple and simultaneous responsibilities with minimal supervision
- Effectively communicate, both orally and in writing, across all levels of the care team and organization
- Intermediate computer skills (use of Microsoft office suite and email)
- Experience with EMR and claims systems a plus
- Bilingual a plus
We offer excellent benefits to eligible employees, including 401(k), holidays, vacations and more. In select states, patient care is provided by an independent physician-owned corporation.
Quad/Graphics is an equal employment opportunity employer. The Company’s policy is not to unlawfully discriminate against any applicant or employee on the basis of race, color, sex, sexual orientation, gender identity, religion, national origin, age, military or veteran status, disability, genetic information or any other consideration made unlawful by applicable federal, state, or local laws. The Company also prohibits harassment of applicants and employees based on any of these protected categories.
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