Nurse Case Manager II- Head and Neck

Job Schedule

Full-time

Scheduled Weekly Hours

N/A

Shift

Day

About the Role

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. Proposes process improvements for determining initial eligibility, benefits, and education for all admissions, leveraging advanced knowledge to assess medical necessity and required level of care to inform physicians. Analyzes and ensures authorization data and escalates inaccuracies. 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 updates 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 addresses identified concerns. Connects patients and caregivers with the right entities to assist with benefits/coverage needs. 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. Recommends and attends professional seminars, workshops, and approved educational programs and workshops. Monitors and reviews operational team data and key metrics applied to own work. Makes suggestions for change or improvement as needed. Ensures adherence to regulatory requirements by implementing policy updates.

Responsibilities

• Promotes learning in others by proactively providing and/or developing information, resources, advice, and expertise with coworkers and members; builds relationships with cross-functional/external stakeholders and customers.
• Completes work assignments autonomously and supports business-specific projects by applying expertise in subject area and business knowledge to generate creative solutions; encourages team members to adapt to and follow all procedures and policies.
• Drives services related to the initial case assessment by: interviewing patients and their families to evaluate needs, goals, and current services independently; identifying and proposing process improvements for determining initial eligibility, benefits, and education for all admissions; analyzing and ensuring authorization data (e.g., authorization data regarding admitting/principle diagnoses, bed type(s), and disposition data for accuracy, after visit summary) and correcting and escalating inaccuracies; recommending and designing research plans that identify new and/or existing options to assure that quality, cost-efficient care is provided; and leveraging advanced knowledge to assess medical necessity for hospital admission and required level of care to inform physicians.
• Provides services related to monitoring and evaluating plan of care by: coordinating resources and services to assure continuity and quality of care, sharing advanced knowledge with others, and developing strategies; updating authorizations, attending case management rounds with clinicians, and updating diagnoses as needed; contacting own patients periodically to assess progress toward treatment milestones and care plan goals, and beginning to coordinate team members to do the same; identifying barriers to achieving goals and ensuring that they are discussed with the patient and care team thoroughly, and guiding team members doing the same; promoting best practices for verifying that all services remain consistent with established guidelines and standards; and documenting/updating the patients case in all medical files while sharing standards with the team.
• Drives services related to the case-planning process by: creating a client-focused case management plan with treatment goals based on the patients and familys/caregivers needs independently; collaborating independently with health-care team, patient, and caregivers to assure plan of care is safe, agreeable, and appropriate; and validating that the plan is consistent with regulatory, accreditation, and regional guidelines independently, and sharing feedback with team members as needed.
• Serves as liaison between internal and external care by: reviewing benefits/services available based on regulations or specific coverage to patients, families, and other members of the community, problem solving identified concerns, and connecting patients/families with the right entities to assist with benefits/coverage needs; providing case management to a caseload of low- and medium-risk patients referred to external facilities/agencies independently; applying strategies and concepts to independently propose recommendations in interdisciplinary team.

Qualifications

• Certified Registered Nurse (RN)
• Bachelor of Science in Nursing (BSN)
• Current California State License as a Registered Nurse (RN)
• Current BLS Certification

Skills

• Collaborative
• Compassionate
• Flexible
• Leadership
• Socially Conscientious
• Trustworthy

Benefits

We offer several benefits to our nurses.

Pay

N/A

Schedule

N/A

Benefits

We offer several benefits to our nurses.