POSITION TITLE:   Medical Case Manager (Per Diem)

DEPARTMENT: Medical Management

REPORTS TO:   Medical Management Team Lead

HOURS:  37.5

FLSA:  Exempt

SALARY GRADE: 12

 

Overview: 

 

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:  

 

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:

Responsibilities 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 telephonic and in-person 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-term goals 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

- Off site visits (such as but not limited to home hospital or Community health centers or other community agencies) as necessary or required

- Provides comprehensive documentation of all activities and contacts in  Case Management 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 Community Outreach Specialists and other team members; providing direct supervision of Community Outreach Specialists as appropriate regarding individual case status

- Serves as a 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

           For more information or to apply, please visit: http://www.nhpri.org/AboutUs/Careers.aspx

Neighborhood is an EOE M/F/D/V and an E-Verify Employer