Job Summary:

To coordinate the comprehensive care for a specific patient population maintaining seamless, cost-effective, and quality patient care. To coordinate a multi-disciplinary team to provide quality patient care to a specified patient group and their families. To evaluate patients for appropriateness and medical necessity. To assess and coordinate efforts to meet resource management expectations and enhance patient outcomes while monitoring the cost of effective patient care. To perform job duties in accordance with the medical center's purpose.

Knowledge, Skills & Abilities:

Knowledge and understanding of patient care for a specified population. Verbal and written communication skills. Interpersonal skills. Knowledge and understanding of computer systems. Ability to work in a team environment. Ability to multi-task. Problem solving skills. Organizational and time management skills.

Responsibilities:

• Performs and documents a comprehensive assessment for a specified group of patients whose diagnosis; procedures; and social, psychological, or financial needs indicate they would benefit from case management.
• Participates in the coordination and development of a plan of care with patients, family, and the interdisciplinary team.
• Reassesses and documents clinical needs and case management interventions.
• Facilitates coordination, timeliness, and appropriate resource for the patient's need.
• Coordinates and implements specific case management activities or interventions to achieve the goals set forth in the case management plan.
• Exhibits a positive and professional attitude as exhibited in behavior and productivity. Leads case management activities within specific patient/service populations.
• Monitors patient progress to determine the effectiveness of interventions and the interdisciplinary plan and impacts a change in the plan at the patient's condition or circumstances change.
• Evaluates appropriateness and medical necessity of the plan of care.
• Facilitates actions to move patients to the appropriate level of care as indicated.
• Collaborates with the social worker and other team members to discuss patients in need of services, resources, or support.
• Utilizes reports, data, and schedules to evaluate measures required to reflect.

The duties listed are general in nature and are examples of the duties and responsibilities performed and are not meant to be construed as exclusive or all-inclusive. Management retains the right to add or change duties at any time.

Physical and Environmental Demands:

Requires occasional exposure to unpleasant or disagreeable physical environment such as high noise level and exposure to heat and cold, frequent exposure to bio-hazardous conditions such as risk of radiation exposure, blood borne pathogens, fumes or airborne particles, and/or toxic or caustic chemicals which mandate attention to safety considerations, occasional activities subject to significant volume changes of a seasonal/clinical nature, frequent work produced subject to precise measures of quantity and quality, frequent bending, occasional lifting and carrying up to 75 pounds, frequent climbing, frequent crouching/stooping, occasional driving, occasional kneeling, frequent pushing/pulling, frequent reaching, frequent sitting, frequent standing, frequent twisting, and frequent walking. (occasional-up to 20%, frequent-from 21% to 50%, constant-51% or more)

Requirements

Education & Experience

Three (3) years of RN experience, one (1) year of which is in case management, utilization review, utilization management, or performance improvement.

Certifications, Licenses or Registration required:

Valid RN license, RN case management certification preferred.