Case Manager

RN Care Manager

The RN Care Manager is responsible a Registered Nurse with years of diverse nursing experience and success in managing complex situations. The RN is an expert in clinical nursing knowledge for specific populations and chronic diseases. This position requires both internal and external interface with providing care management to populations the connect with health insurance attributed lists, emergency rooms, hospitals, primary care services. The care manager functions across the care continuum, interfacing with the multi-disciplinary team to facilitate the best possible clinical outcomes and optimal level of wellness with the most appropriate resource. This role is essential to the success of meeting high risk patient's needs post- discharge and preventing unnecessary readmissions. The care manager will collaborate with the interdisciplinary team to identify, assess, plan, implement, coordinate, monitor, and evaluate options and services in meeting the needs of high risk individuals and their complex medical needs.

Responsibilities

Patient Care

• Evaluate attributed patients identified to provide clinical care management risk attribution.
• Complete psychosocial assessments and develop care plans with identified patient to lower risk threshold for care delivery.

Care Coordination

• Develop a relationship with primary care, specialty services, emergency and hospital networks required for inter-disciplinary care management.
• Facilitates the progression of care by advancing the care plan identification of outcomes, implementation plan and sets goals that are measurable, realistic, and individualized.
• Utilizes hospital, community and national resources to maintain and enhance knowledge and expertise of the care management team.
• Identifies highest quality, most effective post discharge providers and builds relationship to provide highest quality, lowest cost care at the right stage of patients recovery.

Utilization Management

• Ability to utilize care delivery techniques such as teach back and motivational interviewing to support patient success.
• Supports patient to ensure appropriate compliance and support occurs to avoid readmission or poor quality outcomes.
• Monitors outcomes and develops process change to improve care.

Data Integrity

• Respects and upholds patient rights, demonstrates professional integrity, maintains patient confidentiality, discloses all potential or perceived conflicts of interest when appropriate; accepts responsibility and accountability for professional competence.
• Ensures appropriate documentation in the electronic medical record.

Compliance/Safety

• Stays current and complies with state and federal regulations/statutes and company policies that impact the employees area of responsibility.
• If required for position, ensures all certifications and/or licenses are up-to-date and valid prior to expiration dates.
• Completes all company mandatory modules and required job specific training in the specified time frame.
• Responsible for reporting any safety related incident in a timely fashion through the Midas/RDE tool; attends all safety related training programs; performs work in a safe manner; monitors work environment for possible safety issues and ensures others are also performing work in a safe manner.

Qualifications

Education

• Bachelor's Degree in Nursing- Required if hired after December 2018
• Master's Degree in Nursing- Preferred

Certification & Licensures

• Current, unrestricted license in the State of Arizona- Required
• BLS (American Heart Assoc.)- Required
• Fingerprint Clearance Card application number- Required upon hire
• Fingerprint Clearance Card- Required within 90 days of hire

Experience

• Two years as a Registered Nurse- Required
• Care Management or Nurse Navigator experience- Preferred