RN Case Manager
Company: Christus Health
Posted on: July 22, 2021
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
- Utilization of evidence-based clinical practices to manage
member needs, situations, strengths and resources to meet
- 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
- 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
- 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
- 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
- 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
- Adhere to NCQA and URAC standards
- Graduate of an accredited Registered Nursing program,
Bachelor’s Degree required, Master’s degree preferred.
- Case Management Certification through an accredited
- 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
- 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
- Minimum three years in the role of case/utilization
- Five years of experience working with evidence based
- 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
- Current/Active Texas RN Licensure.
- Additional RN certification in Chronic Care or Specialty Care
Keywords: Christus Health, Irving , RN Case Manager, Other , Irving, Texas
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