Case Management RN - Commercial (Non-Exempt Remote)

POSITION SUMMARY

The Case Manager role involves assessing, planning, organizing, implementing, and evaluating the care delivery system across the continuum to enhance quality patient care while promoting cost-effective resource utilization. This role integrates functions such as utilization management, discharge planning, continuity of care, infection control surveillance, and case management.

RESPONSIBILITIES

• Knowledge of prospective payment systems, managed care, infection control surveillance, patient care, disease processes, discharge planning, and continuum of services offered with QCP and externally.
• Knowledge of URAC Standards, nationally recognized case management standards, other regulatory bodies, and QCP activities and services related to the performance of duties.
• Ability to perform data analysis and utilize computer systems to record and communicate information to other services.
• Excellent verbal and organizational skills to facilitate the case management process and ensure patients and customers are served promptly and with respect.
• Identify self by name, role, and responsibility regarding the case management program for identification purposes during verbal interactions with patients, families, caregivers, and providers.
• Clear documentation of medical necessity for all services.
• Complete follow-through for disposition of cases for Medical Director review, potential quality chart reviews, and community resources.
• Access patient needs through evaluation of social, cultural, and medical history.
• Develop an individualized and collaborative case management plan of care with the patient, provider(s), and/or family/caregivers.
• Continually evaluate the plan of care based on changing needs.
• Immediately notify the organization of any changes in licensure or board certification status.
• Provide input on the performance of support staff.
• Other duties as assigned.

REQUIRED QUALIFICATIONS

• Current and active unrestricted licensure in a state or Territory of the United States.
• Two years full-time equivalent providing direct clinical care to the consumer.
• Bachelor's of Science in Nursing or certification in specialty area preferred.

TRAITS AND APTITUDES

• High level of awareness of pertinent details;
• excellent organizational skills;
• excellent verbal and written communication skills;
• must handle pressure effectively;
• professional appearance and demeanor;
• able to maintain confidentiality;
• excellent computer literacy and skills with the ability to master programs needed for position.

PHYSICAL DEMANDS AND WORK CONDITIONS

• Must have excellent written and verbal communication skills as well as the ability to observe, assess, guide, and evaluate others.
• Must be able to hear, speak, and see and to coordinate motor skills.
• Must be able to climb, lift 25 pounds, stoop and bend and reach above head.
• Able to collect data, interpret findings, set priorities, and carry out established plans.
• Able to read, write, and utilize manual and computerized systems of documentation.
• Must read a significant amount of information in a relatively short period of time.