Description |
Company Description:
We are one a prestigious managed care organization that provides high-quality health care coverage to individuals and families through a variety of government sponsored health insurance programs.
Job Description:
Position Summary:
The bilingual English Spanish RN Onsite Case Manager assists with the development, organization, implementation, monitoring and evaluation of activities related to the outcome management of members' healthcare needs at an assigned member hospital. Functions as a clinical resource/educator with the hospital's multi-disciplinary healthcare team in order to maximize quality of patient care, and effectively manage length of stay and utilization of resources.
Essential Duties and Responsibilities:
Performs onsite health assessments to identify areas of concern and need. Ensures that inpatient, outpatient, psychosocial and medical needs of members are addressed and carried out via appropriate education and resources available at their site. Participates in QIP, CCIP, DM, and quality initiative programs.
Troubleshoots 'high utilizer' members to address barriers of care as well as discourage use of Emergency Room and acute inpatient stays. Encourages use of PCP and Out-Patient Clinics to maintain their health and improve wellness.
Encourages members to see their PCP; when they have, reviews PCP's findings with them to ensure they understand treatments and goals in their plan of care.
Communicates with hospital staff (including attending practitioners, utilization review, social workers) to implement appropriate discharge planning for inpatient members and coordinates care accordingly.
Interacts with hospital's Director of Managed Care in order to encourage providers to follow current treatment and disease guidelines. Educates hospital providers about entitlements and benefits.
Documents all interventions with members, providers, assigned hospital staff into MIS system in accordance with established documentation standards to insure integrity of member services.
Other Duties and Responsibilities:
Assists in identifying opportunities for and facilitating alternative care options based on member needs and assessments.
Qualifications Summary:
Education:
Required: Associates degree or Nursing Diploma and 10+ years of related nursing/case management experience will also be considered.
Required licenses, certificates, etc.
Required: State RN License.
Preferred: Certified Case Manager.
Work Related Skills and Experience:
Minimum Qualifications:
Technical Skills:
Complete fluency in reading, writing, and speaking in Spanish is required.
Intermediate Microsoft Word, Excel and Outlook skills are required. Basic PowerPoint and CCMS EMR skills are also required.
Years:
A minimum of three years of managed care or clinical nursing experience in a nursing home, visiting nurse agency, home-based care, HMO organization or hospital dealing with frail and/or elderly populations. This must include knowledge of the concepts and philosophy of case management, utilization review regulations, and relevant medical standards of practice.
Experience:
Good interpersonal and assessment skills.
Demonstrated ability to educate and coordinate resources on an ongoing basis.
Preferred Qualifications:
Experience:
Managed care experience strongly preferred.
Physical Demands:
While performing the occasionally reaching, bending, walking, standing, driving and traveling. This employee will also be frequently pushing/pulling and constantly sitting and keying.
Work Environment:
This employee will constantly be in an indoor environment.
|
Requirements |
See job description.
|
|
