RN Care Manager - Greensboro, United States - Care N Care Insurance Company of North Carolina

Description

Job Description

Role and Responsibilities

Under the direction of the Director of Care Management, the RN Care Manager is responsible for managing high-risk, chronic illness members to promote effective education, self-management support, and timely healthcare delivery to achieve optimal quality and financial outcomes. The RN Care Manager will formulate and implement a care management plan that addresses the member's identified needs by assessing issues, resources, and care goals. The RN Care Manager will advocate for the member and support the member in navigating the health care system. Additionally, the RN Care Manager will collaborate with the interdisciplinary team and members PCP / Health Care Team to identify and support the achievement of the member's short-term and long-term health goals. HTA's Care Management model is to provide longitudinal care management for identified members. A key goal of the RN Care Manager within the longitudinal care management framework is to manage the post-acute care of identified members to avoid and limit poor health outcomes, frequent emergency room visits, and hospital readmissions. Based on the RN's work experience in nursing and knowledge of the health care system, the aims are to provide education and resources to members to ultimately reduce preventable emergency room visits, hospitalizations, and re-admissions.

RN Care Manager

Duties to include:

• Receive all inbound calls from the member population and conduct proactive outbound calls as assigned;
• Collaborate with providers and practice staff in identifying appropriate members for care management, utilizing established Care Management criteria;
• Perform initial and periodic holistic assessments for identified care-managed populations (this includes physical and psychosocial concerns for members as appropriate and the assessment includes a systematic and pertinent collection of data about the health status of the member) and prioritizes members according to intensity, need, and required follow-up;
• Formulate and implement a care management plan that addresses the member's identified needs by assessing the member/family needs, issues, resources, and care goals, determining the choices available to individual members, and educating the patient/family on the choices available to meet their goals.
• Establish a care management plan that is mutually agreed upon by the health care team and the member/family (plans specific mutual self-management goals, objectives, and interventions with the members that are action-oriented);
• Evaluate the effectiveness of the care plan in meeting established care goals, revise the plan as needed to reflect changing needs, issues, and goals, and monitor/evaluate the progress of the member at prescribed minimal intervals;
• Collaborate with the healthcare team to revise the care management plan when changes occur and initiates/participate in care conferences to discuss multidisciplinary team responsibilities, member progress, new problems, etc.;
• Identify and effectively utilize community resources to meet the needs of members/families and facilitate member access to community resources as appropriate and/or refers to Social Work.
• Promote member self-management and empowers members/families to achieve maximum levels of wellness and independence and interact professionally with member/family and involves member/family in the formation of plan of care;
• Perform follow-up calls for members recently discharged from acute hospitalizations with particular emphasis on those members who are at high risk for readmission;
• Collaborate with providers and other healthcare team members including inpatient facilities, outpatient providers, and the Utilization Management department, to initiate transitions of care and facilitate care across the healthcare continuum and optimize clinical and financial outcomes;
• Determine and complete appropriate referrals and serve as a liaison to providers, members, and families for coordination of services;
• Maintain accurate and timely documentation and ensure documentation meets current standards and policies;
• Strive to meet established standards for productivity;
• Participate in regular team meetings and peer review activities, in departmental and organizational committees, as applicable, and assist/support in the orientation of new personnel to promotes collaborative teamwork;
• Meet with the care management team leader (Director of Care Management) and the care management team regularly to provide member updates, identify issues, and develop strategies for resolution;
• Perform all duties and responsibilities by the Nurse Practice Act and by basic principles and guidelines of professional nursing;
• Maintain appropriate professional boundaries with members, families, coworkers, and community providers;
• Maintain a working knowledge of, and adheres to, applicable federal and state regulations including, but not limited to, laws related to patient confidentiality, release of information, and HIPAA;
• Interact harmoniously and effectively with others, focusing on the attainment of organizational goals and objectives through a commitment to teamwork;
• Conform to acceptable attendance and punctuality standards as expressed in the HTA Employee Handbook;
• Abide by the organization's compliance program and requirements; and,
• Be current on all required training for the current year.

The position description is not all inclusive and I may be required to perform other duties as assigned.

Education/Experience:

• Associate Degree in Nursing (BSN or Advanced Degree in Nursing preferred);
• Registered Nurse licensed in North Carolina or a Compact state;
• Current NC RN licensure in good standing;
• Valid NC driver's license;
• Five years of nursing-related care experience and/or home care experience combined (Case Management, Care Management, Telephonic Case Management, and/or Disease Management experience preferred); and
• Local and be able to travel as needed for this position to local facilities.
• Case Management Certification desirable.
• Knowledge of care management concepts along the continuum (advanced clinical knowledge preferred);
• Knowledge of Medicare benefits;
• Experience and ability to use Microsoft Office products and word-processing software;
• Excellent written, verbal, and listening communication abilities and can communicate appropriately and clearly to members, coworkers, and providers;
• Ability to manage conflict, stress, and multiple simultaneous work demands effectively and professionally;
• Ability to successfully articulate the process of attaining goals and outcomes of care management;
• Ability to apply clinical knowledge and experience in a care management role;
• Ability to engage and collaborate with the member and significant others in the care management process;
• Ability to care manage diverse populations without applying one's values;
• Ability to work with minimal supervision within the nursing scope of practice;
• Ability to think critically and analytically and work with minimal supervision;
• Ability to evaluate and appropriately respond to verbal and non-verbal communication from patients in diverse stages of development;
• Ability to use good judgment to protect personal safety while performing duties; and,
• Must be able to drive to local healthcare facilities to meet with members/providers as needed.
• CBG checks and Foley Cath care preferred.
• Clinical knowledge and ability to educate clients of all ages about the following core disease management issues: Diabetes, Hypertension, Hyperlipidemia, CAD, Asthma, COPD, and renal disease required (This is not intended to be an inclusive list of all conditions) preferred.

Qualifications/Skills

Physical Requirements

• Exerting up to 10 pounds of force occasionally (up to 1/3 of the time);
• Negligible amount of force frequently (1/3 to 2/3 of the time) to lift, carry, push, pull, or otherwise move objects, including the human body;
• Sedentary work involves sitting most of the time but may involve walking or standing for brief periods of time; and,
• Jobs are sedentary if walking and standing are required only occasionally, and all other sedentary criteria are met.