Medical Case Manager

Medical Case Manager

 

The Medical Case Manager works collaboratively with the Health Care Team to manage and coordinate care for a specific population of members whose needs represent high clinical and social risk in order to ensure quality and cost-effective member-centered care.

 

Qualifications for this opportunity include:

 

Required:

• Licensed RN, State of RI

• BS Degree or Certification as a CM or RN with 3 years clinical practice

• 3 years experience in acute care

• Computer literacy with Windows based programs

• Strong organizational and documentation skills

• Excellent Customer Service Orientation

• Strong Interpersonal Skills

 

Preferred:

• Clinical Specialty Experience

• Medical Review experience helpful

• Case Management certification a plus

• Clinical Specialty certification a plus

• Bilingual (English/Spanish) a plus

• Practice within the scope of his/her license

 

Duties and Responsibilities for this opportunity include but are not limited to the following:

 

• Practice Case Management within the scope of licensure.

• Utilizes case management principles and sound clinical judgment in coordinating care for a specific member population.

• Performs intensive case management functions for identified individuals in order to promote quality, cost-effective outcomes, including but not limited to:

- Performing a comprehensive assessment

- Care planning activities including the development of interventions, short and long-termgoals in collaboration with member, family, PCP, Behavioral Health Professionals and other involved health care professionals and community agencies, as appropriate

- Implements care plan, facilitates referrals, coordinates services and resources and provides ongoing monitoring and re-evaluation of outcomes

- Continuous monitoring and evaluation of the care outcomes and identification of service gaps

- Regular review and revision of the plan of care in collaboration with the family and appropriate members of the health care team based on the outcomes and evaluative findings.

- Home visits as necessary or required

• Provides comprehensive documentation of all activities and contacts in CMAQE and appropriate software system

• Facilitates referrals and coordinates needed services

• Collaborates with Medical Review Nurse as necessary in identifying needed services and supports

• Calculates cost savings that may result from redirecting member to a more appropriate care setting (i.e. PCP visit rather than ER)

• Communicates with ancillary departments, such as Provider Relations and Member Services, as necessary to meet individual needs of members and providers.

• Meets department and regulatory standards for accuracy, proficiency and documentation in order to communicate decisions and plan of care in an appropriate and timely manner.

• Takes responsibility for professional development, supports a learning environment, and meets professional competency requirements

• Participates in department continuous quality improvement activities

• Provides clinical oversight to HNS and other team members; providing direct supervision of HNS as appropriate regarding individual case status

• Serves as clinical resource to respond to questions from ancillary departments within Neighborhood

• Provides cross-coverage as assigned by Supervisor

• Participates in outreach/marketing activities as needed and as appropriate

• Other duties as assigned by Supervisor

 

Neighborhood is an Equal Opportunity Employer

To apply, please visit our website: www.nhpri.org