Nurse Case Manager

About the role

The Health Research and Analytics (HRA) business line is seeking a highly motivated, full-time Nurse Case Manager to join our team in support of our government customer, U.S. Special Operations Command. This position plays a critical role in advancing the Preservation of the Forces and Family (POTFF) program, which is dedicated to optimizing and sustaining the mission readiness, longevity, and performance of Special Operations Forces (SOF).

Responsibilities

• Provide a full range of professional health nursing principles, practices, and procedures in clinical settings to analyze the full scope of problems associated with providing appropriate, cost-effective care to Department of Defense (DOD) beneficiaries.
• Collect, organize, record, and communicate data relevant to primary health assessments including a detailed medical history to develop time sensitive treatment plans which delineate the expected process of care delivery for selected case managed patients or populations.
• Assess patient care via the telephone, using established protocols to provide appropriate and cost-effective care.
• Establish priorities for patient care monitors and evaluate progress toward the stated goals to provide coordinated, efficient, effective health care to its beneficiaries.
• Oversee discharge-planning activities to ensure ideal timing and sequencing of patient care.
• Facilitate referrals, collaborate with healthcare providers, and manage service agreements to support efficient, effective, and compliant patient care.

Qualifications

• Certified as a case manager by a recognized certifying organization, i.e., Commission for Case Management Certification or American Nurse Credentialing Center.
• At least two years’ nursing experience.
• Current, full, active, and unrestricted license as a Registered Nurse in any U.S. State, the District of Columbia, Guam, Puerto Rico or U.S. Virgin Islands.
• Ability to seek feedback from peers, professional colleagues, clients, and outcomes research, to expand clinical knowledge, enhance role performance, and increase knowledge of professional issues.
• Experience effectively consulting with health care providers at all levels and negotiating with outside providers for services and products to obtain client services and support.
• Possess knowledge of patient education principles and management of complex medical, psychosocial, and financial problems to enhance patient adherence to individualized treatment plans and train peers and staff.
• Maintain credentialing requirements in good standing at a local MTF.
• Possess oral and written communication skills 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.
• Experience in team coordination, facilitation, and communication 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 to ensure adherence within legal and professional parameters.
• Knowledge and skill in using pre-established utilization review criteria to recognize and report actual or potential quality and risk management issues to improve practice and ensure compliance.
• Knowledge and skills in the use of VA/DOD Clinical Practice Guidelines 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 to ensure optimal stewardship of resources.
• Experience using research tools to critically evaluate existing practices, opportunities, and outcomes.
• Knowledge of computers and software applications to conduct data collection, tracking, rendering, and analysis.
• Knowledge of pharmaceuticals, their desired effects, side effects, and complications of their use to gauge their effect on patients and their recovery.
• Possess knowledge of community resources, patient entitlement/benefit eligibility, and ability to access these resources 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, to identify alternative financing sources to which DOD beneficiaries may be entitled.

Additional Qualifications

• May be required to receive and maintain clinical practice privileges.
• Current certification in Basic Cardiac Life Support (BCLS) from the American Heart Association, with documentation provided.
• To obtain and maintain a U.S. government security clearance.