Overview
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Responsibilities
- Participate in all phases of the Case Management Program (CMP) and ensure that the CMP meets established case management (CM) standards of care.
- Provide nursing expertise about the CM process, including assessment, planning, implementation, coordination, and monitoring. Identify opportunities for CM and identify and integrate local CM processes.
- Develop and implement local strategies using inpatient, outpatient, onsite and telephonic CM.
- Develop and implement tools to support case management, such as those used for patient identification and patient assessment, clinical practice guidelines, algorithms, CM software, and databases for community resources.
- Integrate CM and utilization management (UM) and integrate nursing case management with social work case management.
- Maintain liaison with appropriate community agencies and organizations.
- Accurately collect and document patient care data.
- Develop treatment plans including preventive, therapeutic, rehabilitative, psychosocial, and clinical interventions to ensure continuity of care toward the goal of optimal wellness.
- Establish mechanisms to ensure proper implementation of patient treatment plan and follow up post discharge in ambulatory and community health care settings.
- Provide appropriate health care instruction to patient and/or caregivers based on identified learning needs.
Qualifications
- Degree: Associates Degree of Nursing.
- Education: Graduate from a college or university accredited by ACEN, CCNE, or as otherwise outlined.
- Experience: Minimum of two (2) years recent experience within the last four (4) years in professional nursing. For Case Manager (CM): minimum of two (2) years recent nursing or CM experience. For Utilization: six (6) years of broad based clinical nursing experience; experience in UM preferred. Knowledge of InterQual or Milliman guidelines. Proficiency in interpreting medical criteria and performing prospective, concurrent, and retrospective reviews. Familiarity with APGs, DRGs, ICD-9, CPT-4 coding. Minimum of two (2) years of recent nursing experience within the last four (4) years.
- Certification: Possess one of the following certifications: CCM, CDMS, CRRN, COHN/COHN-S, ACCC, CRC, RN-NCM, or CMC.
Seniority level
- Mid-Senior level
Employment type
- Full-time
Job function
- Health Care Provider
Industries
- IT Services and IT Consulting
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📌 Registered Nurse - Case / Utilization Manager
🏢 Decypher
📍 Aviano