Nurse Case Manager, Palliative & Oncology Care

Job Summary:

In addition to the responsibilities listed below, this position is also responsible for providing case management services for palliative or oncology-care patients to ensure quality of care using an interdisciplinary approach; creating population-based reports on outcomes specific to palliative or oncology-care patients; acting as medical liaison between palliative or oncology-care patients, families, community resources, and medical staff/providers; making post disposition follow-up calls to all patients who are not referred to an ambulatory case/care management program with guidance; and facilitating a smooth transfer to home or an alternate facility, and acting as a contact person for dispositions while resolving standard and non-standard issues.

Essential Responsibilities:

• Pursues effective relationships with others by proactively providing resources, information, advice, and expertise with coworkers and members. Listens to, seeks, and addresses performance feedback; provides mentoring to team members. Pursues self-development; creates plans and takes action to capitalize on strengths and develop weaknesses; influences others through technical explanations and examples. Adapts to and learns from change, challenges, and feedback; demonstrates flexibility in approaches to work; helps others adapt to new tasks and processes. Supports and responds to the needs of others to support a business outcome.
• Completes work assignments autonomously by applying up-to-date expertise in subject area to generate creative solutions; ensures all procedures and policies are followed; leverages an understanding of data and resources to support projects or initiatives. Collaborates cross-functionally to solve business problems; escalates issues or risks as appropriate; communicates progress and information. Supports, identifies, and monitors priorities, deadlines, and expectations. Identifies, speaks up, and implements ways to address improvement opportunities for team.
• Drives services related to the initial case assessment by: interviewing patients and their families to evaluate needs, goals, and current services with minimal day-to-day supervision; determining initial eligibility, benefits, and education for all admissions independently; reviewing and entering authorization data (e.g., authorization data regarding admitting/principle diagnoses, bed type(s), and disposition data for accuracy, after visit summary) and identifying and documenting inaccuracies; recommending research plans that identify new and/or existing options to assure that quality, cost-efficient care is provided; and leveraging comprehensive knowledge to assess medical necessity for hospital admission and required level of care to inform physician.
• Provides services related to monitoring and evaluating plan of care by: coordinating resources and services to assure continuity and quality of care, and sharing professional knowledge with team members doing the same; reviewing and updating authorizations, attending case management rounds with clinicians, and reviewing diagnoses as needed; contacting patients periodically to assess progress toward treatment milestones and care plan goals independently; identifying barriers to achieving goals and ensuring that they are discussed with the patient and care team thoroughly independently; verifying that all services remain consistent with established guidelines and standards independently; and documenting/updating the patients case in all medical files independently.
• Drives services related to the case-planning process by: creating a client-focused case management plan with treatment goals based on the patients and familys/caregivers needs under limited direction; collaborating with health-care team, patient, and caregivers to assure plan of care is safe, agreeable, and appropriate with minimal guidance; and validating that the plan is consistent with regulatory, accreditation, and regional guidelines independently.
• Supports efforts to remain updated on current research, policies, and procedures by: attending seminars, workshops, and approved educational programs and workshops specific to professional needs; contributing to the implementation of systems, processes, and methods to maintain team knowledge of community resources; monitoring operational team data and key metrics applied to own work independently; making suggestions for change or improvement as needed independently; and ensuring adherence to policies to meet regulatory requirements.
• Provides services related to patient disposition by: identifying patients ready for disposition planning activities under limited guidance; developing, evaluating, coordinating, and communicating a comprehensive disposition plan in collaboration with the patient, family, physician, nurses, social services, and other healthcare providers and agencies to meet each patients personal, psychosocial, economic, and cultural needs with guidance; and obtaining authorizations/approvals as needed for services for the patient with minimal supervision.
• Connects patients with existing services by: assisting patients with gaining access to care based on their needs and integrating or referring them into existing programs/services independently; referring patients to outside entities, ambulatory case managers, care managers, social workers, and/or internal/external resources as appropriate with minimal guidance; and aiding in making location-specific adaptations as necessary.
• Serves as liaison between internal and external care by: reviewing benefits/services available based on regulations or specific coverage to patients, families, and other members of the community and assisting with problem solving identified concerns under limited supervision; providing case management to a caseload of low- and medium-risk patients referred to external facilities/agencies with minimal supervision; applying standard strategies and concepts to propose recommendations in interdisciplinary team meetings with internal and/or external stakeholders; and leveraging comprehensive knowledge of the patients case to act as a resource for physicians, health plan administrators, and contracted vendors.

Minimum Qualifications:

• Minimum one (1) year of palliative care experience.
• Completion of palliative care training including pain and symptom management, nutrition and hydration, psychosocial and spiritual care, and hospice from the Center to Advance Palliative Care (CAPC).
• Bachelors degree in Nursing or related field AND minimum three (3) years of experience in nursing, case management, or a directly related field.
• Registered Nurse License (California) required at hire

Additional Requirements:

• Knowledge, Skills, and Abilities (KSAs): Written Communication; Confidentiality; Health Care Compliance; Maintain Files and Records; Acts with Compassion; Business Relationship Management; Company Representation; Managing Diverse Relationships; Relationship Building; Member Service; Patient Safety; Quality Assurance and Effectiveness; Community Health

Preferred Qualifications:

• Palliative Care Program Certification from the Center to Advance Palliative Care (CAPC).
• Certified Case Manager (CCM) in the state where care is provided.