RN Case Manager (Telephonic)

RN Case Manager (Telephonic)

Role expectations for the Case Manager includes assessing, planning organizing, implementing and evaluating the care delivery system, across the continuum, to enhance quality patient care while simultaneously promoting cost effective resource utilization. This role integrates the functions of utilization management, discharge planning, continuity of care, infection control surveillance and case management. The Case Manager focuses on the needs of patients/clients and their significant others, while maintaining a balance between outcome, cost, and process. Case Managers analyze and trend data results in order to incorporate efforts and information results with existing systems to optimize efficiency of operational systems through strategic quality leadership. Case Managers combine the roles of clinician, collaborator, consultant and educator to accomplish desired clinical outcomes.

RESPONSIBILITIES:
• Knowledge of prospective payment systems, managed care, infection control surveillance, patient care, disease processes, discharge planning and continuum of services offered with QCP and externally
• Knowledge of URAC Standards, nationally recognized case management standards, other regulatory bodies and of QCP activities and services related to the performance of duties.
• Ability to perform data analysis and to utilize computer systems to record and communicate information to other services.
• Excellent verbal and organizational skills to facilitate the case management process and ensure patients and customers are served promptly and with respect. This includes, but is not limited to identifying self by name, role and responsibility regarding the case management program for identification purposes during verbal interactions with patients, families, caregivers and providers.
• Clear documentation of medical necessity for all services.
• Complete follow through for disposition of cases for Medical Director review, potential quality chart reviews and community resources.
• Access patient needs through evaluation of social, cultural and medical history.
• Develop an individualized and collaborative case management plan of care with the patient, provider(s) and/or family/caregivers.
• Continually evaluate the plan of care based on changing needs.
• Must immediately notify the organization of any changes in licensure or board certification status.
• Provide input on the performance of support staff.
• Other duties as assigned.

REQUIRED QUALIFICATIONS:
• Current unrestricted licensure or certification to practice a health or human services discipline in a state or Territory of the United States.
• Two years full time equivalent providing direct clinical care to the consumer
• Bachelors of Science in Nursing or certification in specialty area preferred. 

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https://www.qualitycarepartners.com/About-Us/Job-Opportunities/