Remote Case Management RN

JOB TITLE: Case Management RN – Commercial (Non-Exempt)

POSITION SUMMARY:

Role expectations for the Case Manager includes assessing, planning organizing, implementing and evaluating the care delivery system, across the continuum, to enhance quality patient care while simultaneously promoting cost effective resource utilization. This role integrates the functions of utilization management, discharge planning, continuity of care, infection control surveillance and case management. The Case Manager focuses on the needs of patients/clients and their significant others, while maintaining a balance between outcome, cost, and process. Case Managers analyze and trend data results in order to incorporate efforts and information results with existing systems to optimize efficiency of operational systems through strategic quality leadership. Case Managers combine the roles of clinician, collaborator, consultant and educator to accomplish desired clinical outcomes.

RESPONSIBILITIES:

· Knowledge of prospective payment systems, managed care, infection control surveillance, patient care, disease processes, discharge planning and continuum of services offered with QCP and externally.

· Knowledge of URAC Standards, nationally recognized case management standards, other regulatory bodies and of QCP activities and services related to the performance of duties.

· Ability to perform data analysis and to utilize computer systems to record and communicate information to other services.

· Excellent verbal and organizational skills to facilitate the case management process and ensure patients and customers are served promptly and with respect. This includes, but is not limited to identifying self by name, role and responsibility regarding the case management program for identification purposes during verbal interactions with patients, families, caregivers and providers.

· Clear documentation of medical necessity for all services.

· Complete follow through for disposition of cases for Medical Director review, potential quality chart reviews and community resources.

· Access patient needs through evaluation of social, cultural and medical history.

· Develop an individualized and collaborative case management plan of care with the patient, provider(s) and/or family/caregivers.

· Continually evaluate the plan of care based on changing needs.

· Must immediately notify the organization of any changes in licensure or board certification status.

· Provide input on the performance of support staff.

· Other duties as assigned.

REQUIRED QUALIFICATIONS:

· Current and active unrestricted licensure in a state or Territory of the United States.

· Two years full time equivalent providing direct clinical care to the consumer

· Bachelors of Science in Nursing or certification in specialty area preferred.

DEMONSTRATE QCP VALUES:

The values of Quality Care Partners are demonstrated on a daily basis and reflected through job duties and responsibilities as evidenced by:

● Caring: Seek to listen, understand and respond to our customers’ needs with care; Communicate with co- workers and customers with positivity and empathy; Be good stewards of QCP resources.

● Excellence: Strive to exceed, not just meet expectations; Always deliver services with accuracy and efficiency; Recognize and utilize your strengths and the strengths of others.

● Improvement: Bring new ideas to create positive change and solutions; Be open to the ideas and suggestions of others; Be an advocate to continuously improve QCP.

● Accountability: Take ownership for your daily decisions; Stay focused on your job and eliminate distractions while at work; Demonstrate QCP values in everything you do.

TRAITS AND APTITUDES:

· High level of awareness of pertinent details; excellent organizational skills.

· Excellent verbal and written communication skills.

· Must handle pressure effectively.

· Professional appearance and demeanor.

· Able to maintain confidentiality.

· Excellent computer literacy and skills with the ability to master programs needed for position.

PHYSICAL DEMANDS AND WORK CONDITIONS:

The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

· Must have excellent written and verbal communication skills as well as the ability to observe, assess, guide and evaluate others.

· Must be able to hear, speak, and see and to coordinate motor skills.

· Must be able to climb, lift 25 pounds, stoop and bend and reach above head.

· Ability to collect data, interpret findings, set priorities and carry out established plan.

· Ability to read, write and utilize manual and computerized systems of documentation.

· Must read a significant amount of information in a relatively short period of time.

EEO STATEMENT:

Quality Care Partners is an equal opportunity employer that is committed to inclusion and diversity. We take affirmative action to ensure equal opportunity for all applicants without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, Veteran status, or other legally protected characteristics.

REPORTING RELATIONSHIPS:

Position Reports to: Health Services Manager

Job Type: Full-time

Pay: $29.82 – $34.98 per hour

Benefits:

• 401(k)
• 401(k) matching
• Dental insurance
• Disability insurance
• Flexible spending account
• Health insurance
• Life insurance
• Paid time off
• Vision insurance

Education:

• Bachelor’s (Preferred)

Experience:

• providing direct clinical care full time: 2 years (Required)
• Case management: 2 years (Preferred)

License/Certification:

• current and active unrestricted RN license (Required)

Work Location: Remote