RN Case Manager
Company: CHRISTUS Health
Location: Irving
Posted on: February 18, 2021
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Job Description:
DescriptionSummary: The Registered Nurse Case Manager
identifies, evaluates and provides management of services for
patients with complex, catastrophic, long term illness or injury,
mental/chemical health, and/or psychosocial issues. To promote
quality, effective outcomes throughout the care continuum, the Case
Manager will utilize disease management knowledge, along with
evidence-based clinical care, to administer all facets of the case
management process including assessment, planning, development of
care plans, implementation of the plan of care, coordination and
oversight of services, and evaluation of options and resources. The
Case Manager acts as a member advocate through coordination and
collaboration on care needs working with primary care physicians,
specialists, members and their families, and community providers.
The position responsibilities also include an understanding of the
impact of social determinants of health and other psychosocial
needs resulting in quality, cost-effective care. Identification of
members who will benefit from case management supportUtilization of
evidence-based clinical practices to manage member needs,
situations, strengths and resources to meet identified
goalsDevelopment of a plan of care focused on improving overall
well-being, assuring use of evidence-based criteria throughout the
continuum of careUnderstanding and planning to assure services
provided work within the boundaries of the member?s plan
eligibilityEngagement in ongoing timely professional collaboration
and communication with the member, member's family and/or
caregivers and healthcare providers according to member's
healthcare needs to enhance positive outcomesResearch and refer
members to community resources (i.e., food insecurities, child
care, mental health/chemical health support)Provide assistance to
support the application of benefits assuring maximization of
benefits to support identified needsPerform ongoing essential case
management activities of reassessment, problem identification,
planning, implementation, coordination, monitoring, and evaluation
of case managed membersEstablish and maintain rapport with
providers as well as ongoing education of providers concerning
appropriate protocolFacilitate negotiations for out of network
careCollaborate with all other departments as appropriate and
required to facilitate the completion of tasks/goalsPerform
telephonic communication with members in case management according
to member needs and within Department of Defense contractual time
framesFacilitate patient wellness and autonomy through advocacy,
communication, education, and identification of service
resourcesIdentification of appropriate providers and facilities,
assuring that available resources are being used in a timely and
cost effective mannerMaintain quality documentation of collected
data, actions taken, and results of actions taken in order to
promote continuity of care within governmental and contractual
requirementsIdentify and present all cases of possible quality
deviation, questionable admissions and out of network services to
physician for review and recommendationAnalyze and present data
related to medical services for cost containmentFollows the
CHRISTUS Guidelines related to the Health Insurance Portability and
Accountability ACT (HIPAA), designed to prevent or detect
unauthorized disclosure of Protected Health Information (PHI)Adhere
to NCQA and URAC standards Requirements: Graduate of an accredited
Registered Nursing program, Bachelor?s Degree required, Master?s
degree preferred. Case Management Certification through an
accredited organization required. Program management experience,
including management of multiple projects at one time. Demonstrated
organizational, time management, prioritization and team work
skills. Analytic ability to prepare and present status reports and
document procedures. Excellent communication skills, judgment,
initiative, critical thinking and problem solving abilities.
Ability to handle and resolve complex issues. Basic knowledge of
computer systems; good typing skills. Excellent customer service
skills. Excellent negotiation skills.Minimum five years of diverse
clinical experience as a Registered Nurse. Minimum three years in
the role of case/utilization manager.Five years of experience
working with evidence based guidelines.Three years of experience
independently managing patients providing clinical guidance.Three
years of experience working with care providers to develop and
manage plans of care.Three years of program/project management
experience focused on patient care.Current/Active Texas RN
Licensure.Additional RN certification in Chronic Care or Specialty
Care preferred. Work Type: Full Time
Keywords: CHRISTUS Health, Irving , RN Case Manager, Executive , Irving, Texas
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