Nurse Case Manager Job Description Sample
Nurse Case Manager
The Nurse Case Manager, hereafter referred to as the Case Manager, shall provide a full range of professional health nursing principles, practices, and procedures in clinical settings in order to analyze the full scope of problems associated with providing appropriate, cost effective care to Department of Defense (DOD) beneficiaries. The Case Manager shall collect, organize, record, and communicate data relevant to primary health assessments including a detailed medical history in order to develop time sensitive treatment plans which delineate the expected process of care delivery for selected case managed patients or populations. The Case Manager shall assess patient via the telephone, using established protocols, in order to provide appropriate and cost effective care. The Case Manager shall establish priorities for patient care monitor and evaluate progress toward the stated goals in order to provide coordinated, efficient, effective health care to its beneficiaries.
The Case Manager shall oversee discharge-planning activities in order to ensure ideal timing and sequencing of patient care. The Case Manager provides professional assistance to health care finders in order to identify patient’s needs for referrals to appropriate health care providers or facilities. The Case Manager shall negotiate, write, finalize, and administer product/service agreements to insure mutual compliance in meeting care goals.
Must have demonstrated skill in understanding diagnoses in order to assist patients to optimize their level of function and self-care. Shall possess demonstrated knowledge of patient education principles and management of complex medical, psychosocial, and financial problems in order to enhance patient adherence to individualized treatment plans and train peers and staff. Shall have a minimum of two years nursing experience and shall be certified as a case manager by a recognized certifying organization, i.e. Commission for Case Management Certification or American Nurse Credentialing Center.
Shall possess the ability to seek feedback from peers, professional colleagues, clients, and outcomes research, in order to expand clinical knowledge, enhance role performance, and increase knowledge of professional issues. Shall have the skills to effectively consult with health care providers at all levels and negotiate with outside providers for services and products in order to obtain client services and support. May be required to receive and maintain clinical practice privileges. Shall maintain credentialing requirements in good standing at a local MTF.
Licensure: Current, full, active, and unrestricted license as a Registered Nurse in one of any U.S. State, the District of Columbia, Guam, Puerto Rico or U.S. Virgin Islands.
Security Clearance Required:
All HCPs shall have and maintain current certification in Basic Cardiac Life Support (BCLS) as certified by the American Heart Association. Documentation of such training shall be provided to the COR. The front and back of the BCLS shall be provided to the Credentialing Department of the MTF they are credentialed through.
Required Minimum Skills
• Oral and written communication skills in order to meaningfully interact with peers, outside agencies, vendors, providers, and Military Health System (MHS) stakeholders to exchange information, provide briefings, presentations, research, and metrics to demonstrate or advance effective, efficient case management practice, outcomes, and organizational/MHS value.
• Skill in team coordination, facilitation, and communication in order to facilitate the exchange of information/ education, enhance goal achievement; augment abilities of client support network, and effect change in system or policy at any level.
• Knowledge of local, state, and federal laws and regulations, professional code of ethics, and practice standards in order to ensure adherence within legal and professional parameters.
• Knowledge and skill in using pre-established utilization review criteria recognize and report actual or potential quality and risk management issues in order to improve practice, and ensure compliance.
• Knowledge and skills in the use of VA/DOD Clinical Practice Guidelines in order to ensure an evidence-based standardized process of care to military beneficiaries.
• Knowledge of the healthcare financial environment and the fiscal dimension of population health in order to ensure optimal stewardship of resources.
• Skill in use of research tools in order to critically evaluate existing practices, opportunities, and outcomes.
• Skill in management of information systems and technology in order to manage individual or population health, continuously improve practice, and effectively communicate practice outcomes to involved stakeholders.
• Knowledge of computers and software applications in order to conduct data collection, tracking, rending, and analysis. Ability to design and present computer-generated outcome analysis information in order to provide timely, effective peer and higher level educational programs or project briefings.
• Knowledge of pharmaceuticals, their desired effects, side effects, and complications of their use in order to gauge their effect on patients and their recovery.
• Knowledge of community resources, patient entitlement/benefit eligibility, and ability to access these resources in order to assist patients/families in optimizing their level of function and self-care.
• Knowledge of current third party regulations and policies, with special emphasis on TRICARE and Medicare benefits and services, in order to identify alternative financing sources to which DOD beneficiaries may be entitled.
Location: Cannon AFB, New Mexico
Equal Opportunity Employer
Nurse Case Manager
Job ID 1900032A
Available Openings 1
PURPOSE AND SCOPE:
Promotes quality patient care, ongoing customer support and case management for Fresenius Kidney Care (FKC) renal patient population (internal and external) by providing guidance, support, care coordination, education and other case management functions as defined by the pertinent program. Manages the implementation of the pertinent program as assigned while acting as the subject matter expert and resource for patients, dialysis staff, physicians and other healthcare professionals. Services are generally provided telephonically but there may be programs where on-site visits to clinics, medical office, hospital or visits to patient homes are required. Programs include but are not limited to the Patient Onboarding, Continuity of Care, Hepatitis C Nurse Advocates and Anemia Case Management programs. Will support FMS's mission, vision, core values and customer service philosophy. Adheres to the FMS Compliance Program, including following all regulatory and FMS policy requirements.
PRINCIPAL DUTIES AND RESPONSIBILITIES:
Utilizes clinical judgment, independent analysis, critical thinking skills, time management skills and detailed knowledge of case management program.
Adheres to company, department, program policies and clinical guidelines to identify, review, assess and allocate patients for program participation according to their identified needs.
Collaborates with the clinical staff, physicians and other members of the patient's healthcare team, to develop an individualized and comprehensive plan of care according to the applicable program specifications.
Ensures the coordination and integration of services as planned in the pertinent program while revising the plan as needed to provide high quality continuity of services and cost-effective service delivery.
Utilizing the telephone and other technical and electronic communication formats to remotely monitor the care of the patient according to the program requirements. There may be situations within the pertinent programs which require the case manager to meet the patient, the patient's family and/or the physician face to face in the home, clinic or medical office setting.
Proactively contacts the patient and/or clinic on a frequent basis as specified in the program details to assess their situation, provide assistance, and answer questions as necessary.
Revises and adjusts the patient care plan as needed to fit the needs of the patient. Provides updates to clinical staff, physician and/or family members as detailed in the program documents.
Identifies patient and/or clinic staff knowledge and understanding deficits regarding their specific program and situation. Provides the appropriate education, support and materials to facilitate informed decision making and understanding.
Provides a strong and effective reciprocal communication process with patients (in applicable programs), clinic staff, physicians and extended care team to ensure all issues and concerns regarding each specific program are addressed and resolved.
Assesses patient conditions, in conjunction with clinic staff, such as the discovery of unreported medical and social conditions, or changes at home that may lead to adverse outcomes and ensures these concerns are referred to the appropriate sources for attention.
Maintains and updates the appropriate software/tracking logs of patients in the program to manage and record required information and data. Generates and analyzes reports as needed for management, identifying trends, anomalies and areas of concern.
Evaluates program processes, identifying options to increase efficiencies and effectiveness of program. Make recommendations to management and assist with implementation as appropriate.
Complies with departmental and program quality standards and quality assessment and performance improvement requirements.
Maintains integrity of Protected Health Information (PHI).
Complies with all company and departmental required data collections and auditing activities.
Act as a resource for the customer to address concerns and questions.
Participates in process improvement activities.
Monitors and reinforces FKC quality goals and the elements of the case management program..
Participates in project-based assignments.
Maintains current knowledge of the departmental program software and the company's clinical information systems
Other duties as assigned.
Additional responsibilities may include focus on one or more departments or locations. See applicable addendum for department or location specific functions.
PHYSICAL DEMANDS AND WORKING CONDITIONS:
The physical demands and work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job. The majority of the day is spent working at a desk. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
Travel and visits to clinics, patient homes, and physicians' offices may be required by program. See program specific job addendums.
- RN required with active unrestricted nursing licensure in practicing state – with the ability to obtain licensure in multiple states.
- BSN preferred.
EXPERIENCE AND REQUIRED SKILLS:
0 – 2 years' of Nephrology Nursing and/or case management experience.
Experience in a role related to patient education and/or case management is preferred.
Certified Case Manager (CCM), preferred.
Must exhibit leadership skills and be able to collaborate with clinic staff.
Must have knowledge of teaching-learning process, principles, and methods of adult education.
Understanding of renal and diabetes disease process and current management practices.
Excellent written and verbal communication is necessary.
Excellent and professional telephone skills.
Ability to function as a part of an integrated team.
Ability to develop positive relationships with patients, families, physicians, staff and other disciplines.
Must be self-motivated, organized and able to plan a diversity of activities, and work independently.
Able to follow oral and written communication, as well as, communicate information to individuals or groups with varying levels of education.
Must exhibit practical computer skills, including experience using Microsoft Office.. PowerPoint skills are preferred. Proficient to advanced typing skills.
EO/AA Employer: Minorities/Females/Veterans/Disability/Sexual Orientation/Gender Identity
Nurse Case Manager
Health Quest was formed through an affiliation of four hospitals: Northern Dutchess Hospital (Rhinebeck, NY), Putnam Hospital Center (Carmel, NY), Sharon Hospital (Sharon, CT) and Vassar Brothers Medical Center (Poughkeepsie, NY). Health Quest also includes affiliated healthcare providers Health Quest Medical Practice and The Heart Center. Together, these hospitals and healthcare providers have devoted themselves to the development of clinical specialties and medical programs and services.
We also count among our partners long-term care facilities, a free-standing radiation oncology center, urgent care centers, a multi-specialty medical practice and a home care service.
HEALTH QUEST IS AN EQUAL OPPORTUNITY EMPLOYER.
The purpose of the RN Case Manager is to provide clinically-based Case management, support the provider and interdisciplinary team in coordinating patient care, with the underlying objective of enhancing quality and cost-effective care. The RN Case Manager provides clinically-based utilization review of all patients receiving care in the hospital.
Uses published criteria to certify medical necessity for admission and continued stay and benchmark evidence-based care progression. The RN Case Manager escalates outlier cases to attending providers to recommend modification of provider documentation or the care plan and to the Physician Advisor for secondary medical necessity review.
The RN Case Manager actively paces the care from physiological and economic perspectives. Has overall accountability for care coordination and transition management for patients within the assigned caseload.
Partners with Providers and Social Worker Case Managers and collaborates with other health care team members to identify appropriate utilization of resources along the care continuum, facilitate timely care coordination, and efficiently manage the length of stay in the hospital. The RN Case Manager collaborates with the Social Worker and health care team to develop a discharge plan appropriate to the patient and family's needs and resources.
- Associates Degree in Nursing
- 3 years' experience in acute care Nursing
- 3 years' experience as a Case Manager or Utilization Management Nurse in an acute care setting.
- PREFER: Bachelor's Degree or Master's Degree in Nursing
Nurse Case Manager
- Who We Are
Patient focused, community oriented, conveniently located and equipped with technology that rivals the nation's most prestigious healthcare systems, Hackensack Meridian Health Mountainside Medical Center offers a comprehensive and growing array of services delivered by caring and highly skilled medical professionals. We're proud of the therapeutic and administrative upgrades we have made. Mountainside Medical Center has been serving Montclair and its surrounding New Jersey communities since 1891. The physicians, nurses and volunteers who are a part of the Mountainside family are your friends and neighbors. We're your community, your hospital and team, working hard for you.
Hackensack Meridian Health Mountainside Medical Center is proud to continue to provide world-class health care services in a community setting. Our 365 bed medical center has successfully transitioned from a stand-alone facility to being part of Hackensack Meridian Health, the most comprehensive and truly integrated network in New Jersey. Mountainside is a joint venture between Hackensack Meridian Health and Ardent Health Services, one of the country's leading private hospital management companies.
We are looking for a dynamic and passionate Nurse Case Manager to join the Mountainside Team!
What You'll Do
The Nurse Case Manager will work within an interdisciplinary team and collaborate with physicians, family members, nurses, and other hospital staff throughout the patient's continuum of care. The Case Manager will provide compassionate quality care while assisting patients and families from pre-admission through discharge planning.
The successful candidate will be able to:
Validate accurate status order to match appropriate level of care
Proactively involved in discharge planning and ongoing assessments
Secure appropriate certification from payers for services provided
Prompt, accurate, and detailed reporting/documentation
Review physician orders and patient progression on a daily basis and intervenes with care coordination as needed
Plan for care need with active involvement of patient, significant others, hospital staff involved in treatment process;
Application of process improvement methodologies in evaluating outcomes of care
Coordination of communication with physicians, nursing, and staff of ancillary departments
Evaluation of care provided against the Length of Stay
Collaboration with Admitting to ensure accuracy of patient demographic and insurance information
Communication with patients and their families around medical plan of care and discharge plan
Assess and plan for discharge needs and arrangements, including leading multi-disciplinary care conferences in conjunction with Nursing
Perform any and all duties assigned
What You'll Bring
Bachelor's degree in Nursing required, Master's degree preferred
Must have a minimum of 3 or more years of acute care nursing experience
Must have a minimum of 2 or more years of case management experience preferably in an acute care facility
New Jersey State license that is active and in good standing
Must have a current BLS certification, a certification in case management highly preferred
Excellent verbal and written communication skills
What We Offer
Medical, dental, and vision insurance
401k with Company match
Company paid basic life insurance and long term disability coverage
Generous paid time off, including an additional extended illness bank
6 Paid Holidays
Advancement and career development opportunities
Hackensack Meridian Health Mountainside Medical Center is an Equal Opportunity Employer and applicants will receive consideration for employment regardless of race, color, 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.
Nurse Case Manager
Nurse Case Manager
Organizes and conducts investigations of alleged or suspected violations of medical practice Act, rules and regulations, including allegations of malpractice, gross negligence, incompetence, abuse, misuse or diversion of prescription drugs, fraud, and other professional misconduct; may exercise the general powers of a peace officer and maybe required to carry a firearm.
Obtains information and gathers facts by conducting interviews with principles, complainants, witnesses and other sources; obtains biological fluid samples and other evidence and maintains evidentiary chain of custody; evaluates findings of investigations; prepares reports and recommendations for consideration in administrative hearings or legal action; provides testimony in such actions as required.
Conducts PMP/pharmacy surveys and inspections and develops evidence pertaining to the excessive, illegal or inappropriate prescription of controlled dangerous substances by persons under investigation.
Serves legal documents such as citations and subpoenas; retrieves revoked or suspended licenses; interviews applicants for licensure in furtherance of licensing requirements.
Works with federal, state and local law enforcement agencies, as needed, on investigations; represents the agency before meetings of professional organizations, seminars, and training programs.
Knowledge, Skills and Abilities Preferred:
Knowledge of; agency policies and procedures; all state and federal legislation related to medical practice, narcotics and prescriptions. Ability to communicate effectively, both orally and in writing and to organize, analyze and interpret electronic medical records/electronic health records and to maintain effective professional working relationships with others.
Education and Experience required:
Education and Experience requirements at this level consist of possession of a valid Oklahoma license as a registered nurse as approved by the Oklahoma Board of Nursing and minimum of three years of professional nursing experience.
Applicants must possess the ability and willingness to perform job-related travel; willingness to carry a firearm and use deadly force as required; have and maintain physical and mental stamina to perform the work and willingness to accept the physical discomforts and/or dangers inherent in the work; be willing to travel frequently and be away from home for extended periods of time; be willing to transfer where needed and to accept assignments anywhere in the state; pass a rigid character and background investigation and within twelve months successfully complete all requirements to become a certified peace officer as required by 59 O.S. 1989, Section 512.
Additional Factors for Consideration:
A one year probationary or trail period may be required.
Veteran's preference points apply only for initial appointment in the classified service.
Nurse Case Manager
WE'RE HIRING REGISTERED NURSE CASE MANAGERS
Full federal benefits package: very competitive pay, ample vacation
- separate sick leave, student loan repayment, relocation assistance, 5% investment matching (TSP), retirement (FERS), health, dental, vision, life + long term insurance, any state license works (no need to get a KS license!) Read more about our benefits by visiting the Army Benefits Center (https://www.abc.army.mil/abc?id=abc_index)
Active, unrestricted RN license, BLS, Graduation from an accredited RN program, one full year of RN case management, US Citizenship
HOW TO APPLY.
To officially apply, please search for openings at Fort Riley, Kansas on USAJOBS.gov. Please also e-mail your resume + license to:
WHAT WE'RE ALL ABOUT
We're an Army hospital located in Fort Riley, Kansas. An active duty Army instillation in Manhattan, Kansas - home to Kansas State University!
We serve a population of nearly 50,000 active duty Soldiers, family members and retirees in the community. Irwin Army Community Hospital is located in Fort Riley, Kansas which is uniquely located in the rolling Flint Hills region of the Midwest. We are nestled between Junction City (pop.17,000) and Manhattan (pop. 57,000). The local area has an abundance of outdoor activities where you'll find unlimited opportunities to fish, hike, swim, and explore!
Enjoy BigXII college sports and entertainment at Kansas State University in Manhattan; as well as a thriving night life and culinary experience. Experience travel simplified at the Manhattan Regional Airport. For international travel, Kansas City International Airport is only two hours away.
Manhattan has been recognized on the following lists for its quality of life:
No. 3 on a list of Best Small Places for Business and Careers (Forbes)
One of the Top 10 Places to Retire (Money Magazine)
One of the Top 50 College Towns in America (Best College Reviews)
Top 10 Best Places to Retire Young (CNN Money)
Top 100 Places to Live in America (Livability)
Irwin Army Community Hospital is a 47-bed hospital. It was designed with the latest medical engineering technology to deliver the best care to our Big Red One Soldiers and mission partners, their families and our retirees.
The hospital was smartly built to accommodate an increase in patient capacity or future growth on Fort Riley. As of summer 2016, the hospital serves 49,426 eligible beneficiaries. On a typical day, it sees 1,594 clinical patients, fills 1,805 prescriptions, runs 1,587 laboratory procedures, performs 11 surgical cases, and delivers three babies.
The new hospital incorporates Evidence-Based Design which influences modern healthcare facility design to promote patient healing and staff well being. The L-shape design separates the inpatient care from the outpatient care clinics.
The staff use their own hallways and elevators outside of the "L." This frees up space for patients and visitors. The layout provides the shortest reasonable path from check-in to exam. It also eases the transition from one department to another should a patient require additional care.
All reception areas in the outpatient side are in the atrium, giving a greater sense of openness. The atrium, or "glass wall," lets in natural light and provides a passive solar heat in the cooler months while reducing it in hotter seasons. Irwin Army Community Hospital celebrates the 100th anniversary of the 1st Infantry Division with the opening of the new hospital in 2016.
WHAT DOES IT MEAN TO BE AN ARMY CIVILIAN?
Civilian employees serve a vital role in supporting the Army mission. They provide the skills that are not readily available in the military, but crucial to support military operations.
The Army integrates the talents and skills of its military and civilian members to form a Total Army. As a civilian employee on #TeamIACH, you are a federal employee. You are not in the Army, you are not deployed, forced moved, and you don't wear a uniform.
You'll work alongside our men and women in uniform who also serve as heathcare professionals. Click here to learn more about civilian government service.
WHEN YOU'RE ON #TEAMIACH,
YOU EITHER TOUCH A PATIENT, OR ENABLE THOSE WHO DO.
JOIN THE TEAM, TODAY.
CONNECT WITH US.
LEARN MORE ABOUT LIVING IN MANHATTAN.
Visit the CVB website here.
LEARN MORE ABOUT LIVING IN JUNCTION CITY.
Visit the CVB website here.
Educate both the patient and members of the health care delivery team about case management, healthcare and treatment options, community resources, insurance benefits, and psychosocial concerns.
Provide advanced practice clinical nursing, administrative and organizational skills in managing the continuity of care for the beneficiary populations.
Engage in problem solving by exploring options to care when available and alternative plans when necessary to achieve desired outcomes.
Provide oversight and input to nursing practice matters.
Provide guidance on establishing appointment protocols to match patient's needs with available resources in a timely manner.
One year of experience which includes independently developing case management patient care plans; conducting case management discussions with a variety of stakeholders; and evaluating appropriateness, quality, and/or cost effectiveness of care.
An active, current registration as a professional nurse in a State, District of Columbia, the Commonwealth of Puerto Rico, or a territory of the United States.
Degree or diploma from a professional nursing program approved by the legally designated State accrediting agency at the time the program was completed.
Basic Life Support (BLS) certification endorsed or sponsored by the American Heart Association (AHA).
Nurse Case Manager
Nurse Case Manager
Naval Healthcare Clinic Hawaii (NHCH) – Pearl Harbor, HI
About the Position:
The Nurse Case Manager provides professional assistance to health care finders to identify patient’s needs for referrals to appropriate health care providers or facilities. Additionally, this position supports initiatives for the Wounded, Ill and Injured (WII).
Position Duties and
- Provide a full range of professional health nursing principles, practices and procedures in clinical settings in order to analyze the full scope of problems associated with providing appropriate, cost effective care.
- Collect, organize, record and communicate data relevant to primary health assessments including a detailed medical history.
- Comply with The Joint Commission standards, MTF’s medical staff bylaws, and all Department of the Navy, Bureau of Medicine and Surgery and local instructions/notices.
- Possess the ability to seek feedback from peers, professional colleagues, clients and outcomes research.
- Skills to consult with health care providers at all levels and negotiate with outside providers for services and products.
- Assess patient via the telephone, using established protocols.
- Establish priorities for patient care, monitor and evaluate progress.
- Oversee discharge-planning activities in order to ensure ideal timing and sequencing of patient care.
- Provide professional assistance to healthcare finders.
- Negotiate, write, finalize and administer product/service agreements.
- Operate automated systems such as CHCS, AHLTA, ADS, CIS and Essentris.
- Current, full, active, and unrestricted license to practice nursing.
- Minimum of two years nursing experience.
- Master’s Degree in Nurse Case Management from a Navy accepted program or certified as a case manager by a recognized certifying organization, i.e. Commission for Case Management Certification or American Nurse Credentialing Center.
- Must be proficient in the English language.
- Must be a U.S. Citizen.
If you do not find interest in this opportunity but know of someone who may, we kindly ask that you refer the individual to Potomac Healthcare Solutions by forwarding this job posting.
Nurse Case Manager
The Penn Occupational Medicine team provides services to employees of the University of Pennsylvania Health System (UPHS) at 3 locations in Philadelphia: Pennsylvania Hospital (PAH), Hospital of the University of Pennsylvania (HUP) and Penn Presbyterian Medical Center (PPMC). They are seeking a full-time Nurse Case Manager to join their team to provide both direct and indirect patient care. Primary duties will include:
Managing care of active worker’s compensation cases involving injured employees, to include coordination of appointment scheduling, diagnostic testing, and interfacing with providers.
Focal point for worker’s comp cases; communicating all aspects of care with injured employees, their supervisors, disability management staff, medical care providers, and third-party payers. Helping place Early Return to Work employees in appropriate areas.
Performing testing associated with annual physical exams and onboarding of employees, to include spirometry, audiometry, vision, N95 mask fit, TB screening, urine drug screens and immunizations.
Monitoring needlestick injuries and body fluid exposures at HUP and outside practices; maintaining logs and presenting data at monthly Environment of Care (EOC) meetings.
Assisting with data collection/management of infectious disease exposures in the workplace
Nurse Case Manager
Description: Nurse Case Manager
Reports to: Medical Manager
Location: Carmel, IN
About Protective Insurance
Protective Insurance specializes in marketing and underwriting insurance for the transportation industry. Backed by our successful history and financial strength, we offer diverse, innovative products in the property and casualty insurance market.
Protective Insurance is seeking a full-time, in-house Nurse Case Manager for its Workers' Compensation Department in Carmel, Indiana. This position involves telephonic medical case management with an emphasis on early intervention, return-to-work planning, coordination of quality medical care on claims involving disability and medical treatment as well as in-house medical reviews as applicable to claim handling laws and regulations.
Develop medical management strategy to ensure injured parties receive appropriate medical treatment directly related to the compensable injury and facilitate a return-to-work plan on claims requiring disability management
Work with medical providers and/or vendors to suggest cost effective treatment alternatives when appropriate
Help ensure that all injured parties are on an aggressive treatment plan
Authorize medical treatment and associated diagnostic testing on assigned claims as allowed by state or policy jurisdictions
Work collaboratively and act as a resource for claim handling staff by providing medical expertise, technical assistance and ensuring continuity of care
Identify cases requiring task assignments to field case managers
Assist in the development of internal procedures and training concerning medical case management
Document all contacts and outcomes related to case activity in claim system
Comply with established best practices, including relationship management
Assist with file management
Perform other duties as required
Candidate must be a Registered Nurse (Bachelor's degree preferred) with an active Indiana state nursing license
Disability case management experience and a minimum 5 years of clinical experience required
Certified Case Manager (CCM) preferred, but not required at date of hire; however, the selected candidate will be required to obtain within 2 years of hire
Understanding of disability/workers' compensation laws or auto first-party medical preferred
Knowledge of medical causation and relatedness, as well as use of medical treatment protocols and physician advisor/peer review program
Appropriate license per state regulation; obtain state licensure where telephonic NCM will be provided
Proficient knowledge of Microsoft Office programs
Very strong oral and written communication skills
Strong customer service skills
Nurse Case Manager
Job Summary: The BIDMC Nursing Mission is to build on a legacy of nursing excellence by caring with compassion, advancing the art & science of nursing, and advocating for the health of patients, families, and communities. The Nurse Case Manager provides utilization management, care coordination and discharge planning for an assigned patient case load. This role is patient-focused, outcome-oriented and based on a general and speciality professional standards, and functions within a multidisciplinary practice model. Training, evaluation and competencies for this role are overseen by a Nurse Leader to the department.
Conducts concurrent daily chart review, investigating patient history, symptoms, clinical status, and treatment utilizing Interqual ISD criteria as a tool to determine a patient's severity of illness and the intensity of service.
Works with multidisciplinary team to develop treatment plans, including contingency plans.
Leads daily case management rounds on assigned unit. Participates in house staff rounds.
Provides necessary information to appropriate organization to obtain continued stay certification; assesses payers' and referring physicians' needs in regard to content and frequency of communications.
Facilitates early referrals to social work, rehab services, patient advocacy, and quality management as needed.
Associate's degree in Nursing required. Bachelor's degree in Nursing preferred.
License Registered Nurse required.
1-3 years related work experience required.
Advanced skills with Microsoft applications which may include Outlook, Word, Excel, PowerPoint or Access and other web-based applications. May produce complex documents, perform analysis and maintain databases.
Certified Case Manager.
Previous clinical nursing experience and/or case management experience.
Decision Making: Ability to make decisions that are guided by precedents, policies and objectives. Regularly makes decisions and recommendations on issues affecting a department or functional area.
Problem Solving: Ability to address problems that are highly varied, complex and often non-recurring, requiring staff input, innovative, creative, and Lean diagnostic techniques to resolve issues.
Independence of Action: Ability to set goals and determines how to accomplish defined results with some guidelines. Manager/Director provides broad guidance and overall direction.
Written Communications: Ability to summarize and communicate in English moderately complex information in varied written formats to internal and external customers.
Oral Communications: Ability to comprehend and communicate complex verbal information in English to medical center staff, patients, families and external customers.
Ability to demonstrate in-depth knowledge of concepts, practices and policies with the ability to use them in complex varied situations.
Team Work: Ability to lead and direct multiple collaborative teams for large projects or groups both internal and external to the Medical Center and across functional areas. Results have significant implications for the management and operations of the organization.
Customer Service: Ability to provide a high level of customer service and staff training to meet customer service standards and expectations for the assigned unit(s). Resolves service issues in the assigned unit(s) in a timely and respectful manner.
Age based Competencies:
Employees in this job must be competent to provide patient care to the following age groups: Neonatal:Birth to 6 months, Young adult: 16-30 years, Middle Age: 30 - 60 years, Elderly: 60 -.
Physical Nature of the Job:
Sedentary work: Exerting up to 10 pounds of force occasionally in carrying, lifting, pushing, pulling objects. Sitting most of the time, with walking and standing required only occasionally
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