Nurse Case Manager

Job Summary

Provides case management services to a caseload of low- and medium-risk patients. Interviews patients and their caregivers to evaluate needs, goals, and current services. Determines initial eligibility, benefits, and education for all admissions, assessing medical necessity and required level of care to inform physicians. Reviews and enters authorization data. Develops a client-focused case management plan in collaboration with healthcare team, patient, and caregivers that is consistent with regulatory, accreditation, and regional guidelines. Assists patients with gaining access to care based on their needs, making referrals as appropriate. Coordinates resources and services to assure continuity and quality of care. Attends case management rounds with clinician and reviews authorizations and diagnoses as needed. Assesses patient progress toward treatment milestones and care plan goals. Identifies barriers to achieving goals and ensures that they are discussed with the patient and care team thoroughly. Verifies that all services remain consistent with established guidelines and standards. Documents the patients case in all medical files. Reviews benefits/services available to patients, caregivers, and other members of the community and assists with problem solving identified concerns. Identifies patients ready for disposition planning activities. Develops and communicates a comprehensive disposition plan in collaboration with the patient, caregivers, physician, nurses, social services, and other healthcare providers and agencies. Obtains authorizations as needed for patient services. Attends professional seminars, workshops, and approved educational programs and workshops. Monitors operational team data and key metrics applied to own work. Makes suggestions for change or improvement as needed. Ensures adherence to policies to meet regulatory requirements.

Priorities and Key Responsibilities

• Pursues effective relationships with others by proactively providing resources, information, advice, and expertise with coworkers and members.
• Listens to, seeks, and addresses performance feedback; provides mentoring to team members.
• Pursues self-development; creates plans and takes action to capitalize on strengths and develop weaknesses; influences others through technical explanations and examples.
• Adapts to and learns from change, challenges, and feedback; demonstrates flexibility in approaches to work; helps others adapt to new tasks and processes.
• Supports and responds to the needs of others to support a business outcome.
• Completes work assignments autonomously by applying up-to-date expertise in subject area to generate creative solutions; ensures all procedures and policies are followed; leverages an understanding of data and resources to support projects or initiatives.
• Collaborates cross-functionally to solve business problems; escalates issues or risks as appropriate; communicates progress and information.
• Supports, identifies, and monitors priorities, deadlines, and expectations.
• Identifies, speaks up, and implements ways to address improvement opportunities for team.

Essential Responsibilities

• Pursues effective relationships with others by proactively providing resources, information, advice, and expertise with coworkers and members.
• Listens to, seeks, and addresses performance feedback; provides mentoring to team members.
• Pursues self-development; creates plans and takes action to capitalize on strengths and develop weaknesses; influences others through technical explanations and examples.
• Adapts to and learns from change, challenges, and feedback; demonstrates flexibility in approaches to work; helps others adapt to new tasks and processes.
• Supports and responds to the needs of others to support a business outcome.
• Completes work assignments autonomously by applying up-to-date expertise in subject area to generate creative solutions; ensures all procedures and policies are followed; leverages an understanding of data and resources to support projects or initiatives.
• Collaborates cross-functionally to solve business problems; escalates issues or risks as appropriate; communicates progress and information.
• Supports, identifies, and monitors priorities, deadlines, and expectations.
• Identifies, speaks up, and implements ways to address improvement opportunities for team.

Knowledge, Skills and Abilities

• Ambiguity/Uncertainty Management
• Attention to Detail
• Business Knowledge
• Communication
• Critical Thinking
• Cross-Group Collaboration
• Decision Making
• Dependability
• Diversity, Equity, and Inclusion Support
• Drives Results
• Facilitation Skills
• Health Care Industry
• Influencing Others
• Integrity
• Learning Agility
• Organizational Savvy
• Problem Solving
• Short- and Long-term Learning & Recall
• Teamwork
• Topic-Specific Communication Knowledge, Skills and Abilities
• (Core)
• (Functional)

Minimum Qualifications

• Bachelor's degree in Nursing or related field
• Minimum three (3) years of experience in nursing, case management, or a directly related field
• Registered Professional Nurse License (Georgia) required at hire

Preferred Qualifications

• Certified Case Manager (CCM) in the state where care is provided
• Basic Life Support (BLS) Certification