Large Case Manager RN

Lucent Health Solutions LLC•Nashville, TN

About The Position

The Large Case Manager RN works with the team to provide appropriate, comprehensive, proactive onsite and telephonic case management for plan participants with chronic or catastrophic illnesses or injuries. The role promotes high-quality, appropriate, cost-effective healthcare in accordance with applicable laws, CCM/CMSA Standards of Practice, company policies and procedures, and AAHC/URAC guidelines. Under the direction and supervision of a Certified Case Management Professional, the Case Manager acts as a patient advocate and performs all phases of the case management process. This includes assessing medical and psychosocial needs; creating and evaluating individualized care plans; coordinating treatment and services; supporting informed patient decisions; facilitating communication among care team members; and maintaining timely, factual, organized documentation. The Case Manager works within health plan provisions and remains involved from as early as possible through the course of the illness or injury.

Requirements

Registered Nurse with a minimum of 5 years of clinical experience.
Active, unrestricted multistate license.
Recent clinical experience.
Excellent written, telephone, and computer skills.
Positive, proactive, team-oriented approach and attitude.
Time-management and organizational skills.
Flexibility and ability to work independently.

Nice To Haves

CCM, CRRN, OCN, or other pertinent certifications.

Responsibilities

Explain the role and scope of case management activities to patients, disclose that gathered information will be shared with the payer, and obtain consent for case management activities.
Assess individual needs related to the patient's medical condition and care, including relevant psychosocial issues.
Identify issues that could interfere with the provision of high-quality, appropriate, cost-effective care.
Develop individualized action plans that coordinate necessary treatment and services, consider benefit plan design and coverage, and establish measurable goals and contingency plans.
Provide information that enables patients to make informed decisions and include them in the care-planning process.
Facilitate communication of the patient's wishes to members of the healthcare team and, when appropriate, discuss advance directives with the patient or family.
Obtain acceptance of the plan from the patient, family, payer, and providers before implementation.
Work within health plan provisions and refer patients to providers assessed for quality through appropriate research, credentials, accreditations, outcomes, or other available information.
Regularly evaluate care plans for effectiveness, satisfaction, quality of life, cost-effectiveness, treatment compliance, and the needs of involved parties; revise plans as circumstances change.
Maintain well-organized, objective, factual, clear, concise, and timely case documentation.
Act ethically as a patient advocate while following case management concepts, industry standards, and guidelines.
Become involved in case management as early as possible after onset or diagnosis and remain involved throughout the illness or injury.