CASE MANAGER SPECIALIST
Coordinates and facilitates interdisciplinary provision of comprehensive, patient-centered, quality health care throughout the continuum for patients with acute and chronic health conditions. Fosters achievement of optimal health care outcomes within accepted standards of care. Serves as an expert resource to the healthcare team regarding the continuum of care, efficient use of resources, Best Practice protocols, team-based care, quality indicators and improvements, and regulatory requirements. Ensures a smooth transition of care between multiple health care environments with planned handoffs. Partners with patients and families in identifying health care issues and barriers to self-care in order to set priorities and engage in appropriate interventions. Demonstrates cultural agility and employs health literacy guidelines to provide education regarding self-management strategies. Utilizes rapid quality improvement cycles to continuously monitor, evaluate, measure, and report progress of interventions and outcomes. Paces the case to assure appropriate and fiscally sound care coordination across the continuum.This is a non-exempt position for on-call employees with unpredictable hours and schedules.
Education:Academic degree in nursing (BSN or higher) required. Exceptions may be made until December 31, 2020 for current Legacy employees who demonstrate that they are actively enrolled in an accredited program and are making meaningful progress toward completion of a BSN (or higher, if undergraduate degree is other than nursing); demonstrated evidence of course completion will be required at the end of each term, and will be tracked by the individual’s manager; any exception to the BSN requirement by December 31, 2020 will need approval of the Nurse Executive Committee. MSN preferred.
Experience: This position requires extensive knowledge of disease management to include diagnostics, treatment and prognosis, community resources and healthcare reimbursement. Minimum 2 years clinical nursing experience required. Relevant experience in one or more of the following healthcare areas preferred:
Coordination of community resources
Care management of diverse patient populations
Knowledge of levels of care throughout the health care continuum to include; inpatient, emergency care, rehab, home health, hospice, long term acute care, SNF, ICF, ALF with an overall understanding of utilization management and resource management.
Working knowledge of Care Management models across the continuum.
Licensure/Certification:Current applicable state RN licensure. Case management certification preferred, and required within 3 years of hire/transfer into this job if hired on/after June 1, 2014. Case management certification required for current incumbents by June 1, 2017.
Knowledge of six core components of case management:
Healthcare management and delivery
Principles of practice i.e. CMS guidelines, Interqual criteria
Case Management concepts
Excellent organizational skills
Health literate oral and written communication skills for effective interaction with all members of the patient’s health care team
Knowledge of transitional planning to and from all venues
Ability to determine and access appropriate community resources
Ability to engage patient/family in discussion of health care goals and decisions with attention to cultural and health literacy implications
Ability to adhere to and implement regulations in an effective manner. Must serve as a resource to all team members regarding regulatory issues.
Keyboard skills and ability to navigate electronic systems applicable to job functions.
PREFERRED EMPLOYEE PROFILE
Follow guidelines set forth in the Preferred Employee Profile.