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Case Manager - Bloomington, United States - HealthPartners
Description
The purpose of the Case Manager role is to provide support to patients, their families, and physicians in addressing medical and social concerns; educate and empower patients and families to make informed personal health care decisions; and facilitate communication between patient, physician, health plan and community.
ACCOUNTABILITIES:
Member Focus
Ensures all activities are member-focused and individualized, resulting in personalized attention to each patient's unique needs.
Identifies interventions and resources to assist member reaching personal health related goals.
Identifies patterns and episodes of care that are predictive of future needs and services.
Integration
Integrates clinical and psychosocial information for case identification and individual patient assessment to develop action-oriented and time-specific planning and implementation of appropriate interventions.
Facilitates integration of patient care by encouragement of effective communications between patients, families, providers, health plan and care system programs, and community-based services.
Adheres to department policy and procedure in daily activities.
Coordinates service coverage with appropriate funding sources when indicated.
Works with Supervisor, Case Management, Government Programs department and Member Services department to ensure compliance with Medicare requirements and regulations.
Communication
Effectively communicates with patients and their families to provide them with a better understanding of their health, health care benefits, and health care system.
Effectively and routinely communicates with patients, families, physicians and health care team members to facilitate successful collaboration resulting in high levels of member/patient/family/provider satisfaction.
Provides educational information and materials to members to support preference sensitive decisions.
Provides regular reporting of member outcomes to Case Management leadership according to defined process.
Identifies and promptly reports potentially adverse situations to leadership as outlined in department policy and procedure.
Identifies and promptly reports high cost cases for reinsurance.
Maintains current and accurate documentation and case management files in accordance with Case Management policy and procedure.
Maintains confidentiality of information in accordance with department and corporate policies.
Relationships and Team Building
Establishes and maintains good working relationships within the Case Management department, with other HealthPartners departments, and with other health team participants.
Supports other team members in achieving patient centered goals.
Assists supervisor in maintaining a cohesive Case Management team by contributing to a collaborative, respectful, and diverse environment.
Participates in and contributes to appropriate departmental and/or organizational meetings.
Technology
Maintains knowledge of and effectively uses automated applications and systems.
Identifies deficits in technological literacy and seeks appropriate training under guidance of supervisor.
Maintains maximum individual productivity through proficient use of automated systems.
Personal Development
Participates in ongoing independent study and education-related professional activities to maintain and increase knowledge in the areas of Case Management, patient care services, and benefit packages for development of effective case management skills.
Demonstrates responsiveness to and appreciation of constructive feedback and recommendations for personal growth and development.
Maintains current, active Minnesota nursing licensure.
May maintain current, active nursing licensure in other states as assigned.
Other Duties
Willingly participates in various committees, task forces, projects, and quality improvement teams, as needed and assigned.
Performs other duties as assigned.
CURRENT DIMENSION:
Directly reports to Supervisor, Case Management.
Directly manages caseload with anticipation of up to 85 members with complex needs.
Interacts with medical, administrative, and front line staff within and outside the organization in order to collaborate on members care.
REQUIRED QUALIFICATIONS:
Registered Nurse with current unrestricted license in the State of Minnesota, BSN preferred. License free of history of restrictions and/or sanctions in the past 10 years in all states with current or past licensure.
Minimum of 3 years clinical practice experience in an acute care setting; minimum of 3 years relevant utilization review, discharge planning, or case management experience; and current clinical knowledge.
Demonstrated effective, independent nursing judgment and skills.
Demonstrated skill and experience in effectively collaborating with care team members, using a high level of expertise in written, oral and interpersonal communication.
Demonstrated working knowledge of quality improvement, utilization management, benefit plans, fiscal management, and various payment methodologies preferred. Understanding of healthcare and/or HMO industry.
Demonstrated skill in effective use and management of automated medical management systems.
Demonstrated flexibility, organization, and appropriate decision-making under challenging situations.
Basic computer skills
CHALLENGES:
Maintaining member focus in a rapidly evolving environment.
Influencing team members and colleagues to work collaboratively in achieving the goals and objectives of the Case Management Program.
Contributing a positive team building approach as a member of the Case Management team, and a global member of the Case Management Department.
DECISION-MAKING:
Makes independent decisions within the scope of this position's accountabilities and determines the need for and the timing of consultation with Case Management leadership and/or Medical Director.
Uses professional clinical judgment, organizational knowledge, industry knowledge, and common sense in determining appropriate alternatives for members/patients/families, consulting with leadership and/or Medical Director, when indicated.
Makes recommendations to leadership regarding policy development needs and/or changes.
We are an Equal Opportunity Employer and do not discriminate against any employee or applicant for employment because of race, color, sex, age, national origin, religion, sexual orientation, gender identity, status as a veteran, and basis of disability or any other federal, state or local protected class.
