RN Case Manager
Company: CHRISTUS Health
Location: Irving
Posted on: February 20, 2021
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Job Description:
Job Description: Description Summary: 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 support *
Utilization of evidence-based clinical practices to manage member
needs, situations, strengths and resources to meet identified goals
* Development of a plan of care focused on improving overall
well-being, assuring use of evidence-based criteria throughout the
continuum of care * Understanding and planning to assure services
provided work within the boundaries of the member's plan
eligibility * Engagement 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 outcomes * Research 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 needs * Perform ongoing essential
case management activities of reassessment, problem identification,
planning, implementation, coordination, monitoring, and evaluation
of case managed members * Establish and maintain rapport with
providers as well as ongoing education of providers concerning
appropriate protocol * Facilitate negotiations for out of network
care * Collaborate with all other departments as appropriate and
required to facilitate the completion of tasks/goals * Perform
telephonic communication with members in case management according
to member needs and within Department of Defense contractual time
frames * Facilitate patient wellness and autonomy through advocacy,
communication, education, and identification of service resources *
Identification of appropriate providers and facilities, assuring
that available resources are being used in a timely and cost
effective manner * Maintain quality documentation of collected
data, actions taken, and results of actions taken in order to
promote continuity of care within governmental and contractual
requirements * Identify and present all cases of possible quality
deviation, questionable admissions and out of network services to
physician for review and recommendation * Analyze and present data
related to medical services for cost containment * Follows 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, Healthcare , Irving, Texas
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