RN High Risk Case Manager

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As a High-Risk RN Case Manager on our Readmission Case Management Team, you can expect to have a caseload of 40-60 members. We work with multiple Medicare Advantage plans as well as BUFC-ACC members to support their health needs. You will work alongside a LMSW, Pharmacy Team, and Registered Dietician to ensure a member’s health specific needs are met.

This is a full-time salaried role. Expected hours are Monday through Friday, 8:30AM to 4:30PM. This role requires telephonic, HOME VISITS, and televisit platforms.

POSITION SUMMARY
This position will be responsible for case managing the complex chronic and rising risk members in the populations where case management is delegated to do so. This position will be the main point of contact for members and providers across care settings. The aim is to better manage patients in the ambulatory setting by engaging members identified high risk or at risk for high utilization, cost of care, transition of care and or chronic disease burden. This position engages the appropriate resources within the multidisciplinary team to achieve optimal results for the patient, family, and care givers. The role provides comprehensive care coordination, interventions and education to minimize barriers in managing chronic complex conditions within the delegated population. This position develops a member centered plan of care the implements, monitors, documents the utilization of resources, progress of the members throughout the continuum of care. The role will coordinate care and services based on the members unique health care needs.

CORE FUNCTIONS
1. Manages the members health, emotional and social needs across the health care continuum (longitudinal support) to achieve the optimal health management in the following areas: clinical, financial, operational, and member experience.

2. Assess, triage and identify care coordination and chronic complex disease education needs based on member specific needs. Provides disease management education and interventions or identifies care coordination referral needs to in ancillary areas to provide optimal disease management support (i.e. pharmacy, registered dietician, social work, palliative, etc.).

3. Provides care based on the best evidence available and may participate in research activities within clinical /case manager practice. Participates in unit or facility-based workgroups. Interacts and participates in the education, role development, and orientation of facility personnel, patients, students, families and visitors. Promotes/supports growth of others through precepting and mentoring when appropriate.

4. Contributes to society through activities that lead to excellent members outcomes through timely, effective, efficient, equitable, and safe care. Actively participates in the improvement of national nursing and case management quality indicators and outcomes. Such activities may include participating in professional organizations.

5. Educates internal members of the health care team on care management and managed care concepts. Facilitates integration of concepts into daily practice.

6. Promotes a more active and informed role in patient self-care; navigates patients identified as high-risk across the continuum, longitudinally.

7. Completes assessment and reassessments according to patient need and as outlined in policy and according to accreditation standards. Documents assessment, planning, implementation and evaluation in the patient member record. Documentation is legible, timely and in accordance with policy. Documentation reflects objective/subjective data, nursing interventions, education, care coordination and members progress to plan of care.

8. Interacts with all levels of staff in a variety of departments, physicians, payers, members, families and external contacts, such as employees of other health care institutions, community providers and agencies, concerning the health care and case management needs of the member. Interacts with other health care providers in numerous settings in order to report and ask for or clarify information. Synthesizes and prioritizes data from multiple sources to provide support for the human response of the patient and family to changes in health status.

MINIMUM QUALIFICATIONS

EEO/Disabled/Veterans

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