RN Case Manager Bilingual (English/Spanish)

This position is identified as level three and must ensure the security and confidentiality of records and information to prevent substantial harm, embarrassment, inconvenience, or unfairness to any individual. The integrity of information must be maintained as outlined in the company Administrative Manual. Segregation of duties will be used to ensure errors or irregularities are prevented or detected on a timely basis by employees in the normal course of business.

About the Role

The RN Case Manager plays a critical role in optimizing patient care and resource utilization. The incumbent is responsible for assessing, planning, implementing, coordinating, monitoring, and evaluating comprehensive care plans to meet individual health needs. This role focuses on quality patient outcomes and cost-effective healthcare delivery and may encompass general medical case management or specialize in high-acuity areas and/or high-cost areas such as high-risk obstetrics and neonatal care, chronic disease management, and/or mental health support (excludes Behavioral Health).

Responsibilities

• Assesses, plans, implements, coordinates, monitors, and evaluates options and services required to meet an individual’s health needs through the use of plan benefits and community resources to facilitate appropriate cost effectiveness and cost containment measures are met.
• Practices nursing within the scope of licensure and adheres to policies, procedures, regulations, URAC standards, and individual state regulations. Makes decisions based on facts and evidence to ensure compliance, appropriate level of care, and patient safety.
• Provides specialized education and knowledge on disease-specific conditions as needed and assigned.
• Remains current with up-to-date medical and surgical procedures, products, healthcare services and drugs, general trends in healthcare delivery, enterprise procedures, policies, and contracts.
• Serves as a liaison facilitating a collaborative process which includes patients, families/caregivers, physicians, hospital discharge planners, home care providers, and other ancillary providers to promote quality of care, cost effectiveness, accessibility, and appropriateness of service levels.
• Works proactively with referrals from multiple sources to identify appropriate candidates for case management, explains services ensuring voluntary agreement of services, and maintains a minimum patient caseload in a timely manner.
• Other duties as assigned.

Requirements

• Bachelor's degree in Nursing preferred.
• Registered Nurse (RN) with current active state license in good standing in the state(s) where job duties are performed required.
• Case management certification required. If certification is not obtained prior to employment, must obtain URAC recognized within three (3) years of hire as a RN Case Manager. Acceptable certifications: Certified Case Manager (CCM), Accredited Case Manager (ACM), and Registered Nurse - Board Certified (RN-BC).
• Minimum four (4) years' clinical practice experience in at least one of the following areas: case management, home health, critical care, medical/surgical, discharge planning, concurrent review, or obstetric/neonatal care.

Skills

• Independence
• Detail oriented
• Administrative Process
• Affinite CM
• Affinite UM
• CCI Edits
• Collaborative Communications
• Critical Reasoning
• Cross-Functional Planning
• Customer Relationship Management (CRM)
• Customer Service Workstation
• Deductive Reasoning
• Five9
• Information Security
• Interpersonal Relationship Management
• Microsoft Excel
• Microsoft Office
• Microsoft Outlook
• Microsoft PowerPoint
• Needs Assessment
• Oral Communications
• Problem Sensitivity
• Researching
• Sound Judgment
• Support Coordination
• Written Communication

Certifications

• Accredited Case Manager (ACM) - American Case Management Association (ACMA)
• Certified Case Manager (CCM) - The Commission for Case Manager Certification (CCMC)
• Registered Nurse (RN) - Arkansas State Board of Nursing

Employment Type

Regular

ADA Requirements

General Office Worker, Semi-Active, Campus Travel - Someone who normally works in an office setting or remotely, periodically has lifting and carrying requirements up to 40 lbs, and routinely travels for work within walking distance of the location of primary work assignment as essential functions of the job.