Catastrophic Nurse Case Manager - Southern CA

Responsibilities

• Processes cases utilizing using the outcome management model and tools and/or any alternate customer specified model and tools
• Obtains written authorization for case management services as well as release of information
• Affirms the client/family to identify their strengths and resources; problems; psychosocial, financial, and medical history; current status; diagnosis; prognosis; functional status; goals; current treatment plan; and needs
• Develops a plan of care with through interdisciplinary collaboration, which identifies realistic short- and long-term goals
• Identifies, secures, and coordinates the services and resources to implement the plan
• Marks up the services being provided for continued appropriateness and reports to TPAs and insurance carrier
• Evaluates the client’s progress, the plan, and the appropriateness of the services provided, with modifications as necessary
• Provides ongoing instruction to the client and family regarding the injury/disease process, treatment options, and present care
• Promotes the client’s/family’s self-advocacy skills to achieve maximum self-sufficiency
• Demonstrates effective, accurate, and timely verbal and written communication in all work situations
• Identifies and discloses all situations which might result in exposure to legal liability and/or are indicative of poor quality care negatively affecting the client

Qualifications

• Registered nurse required
• BSN preferred
• Certified Case Manager (CCM) preferred
• Three years of full-time related Catastrophic Case Management experience