NURSE CASE MANAGER I P

NORTH EAST MEDICAL SERVICES•Burlingame, CA

About The Position

Nurse Case Managers are licensed nursing professional responsible for coordinating continuum of care and discharge planning activities, developing individualized person- centered care plans and goals, and facilitating case conferences among all service providers for a caseload of assigned patients. Nurse Case Managers act as consultant to the clinical team, service lines, and other departments regarding patient assessment and patient care, and participate in program development and quality improvement initiatives in their role, by applying guidelines and collaborating with multidisciplinary teams, Case Managers influence and direct the delivery and quality of patient care. The objectives are to facilitate timely discharges, prompt and efficient use of resources, achievement of expected outcomes, collaborative practice, coordination of care across the continuum, and performance/quality improvement activities that lead to optimal patient outcomes. Nurse Case Managers differ from other roles in professional nursing/health care practice in that they do not provide direct medical care to patients; rather, a Nurse Case Manager will be assigned to specific patients to ensure that the medical services and treatments are accomplished in the most financially and clinically efficient manner. ESSENTIAL JOB FUNCTIONS: Applies professional clinical skills and expertise in the assessment, planning, implementation, and coordination of necessary healthcare services. Develops and manages individualized plan of care to assure consistent, timely, and appropriate care is provided in a patient-focused manner; collects data, assesses needs, identifies problems and options, plans appropriately, sets goals, monitors and evaluates progress. Provides an interdisciplinary process in which healthcare team members collaborate with patients and their families to support quality care and to ensure that patient's care is continuous and integrated among all service providers. Provides disease management to patients who have certain diseases such as end stage renal disease, cancer, and palliative care. Manages patients in different case management programs such as the Chronic Care Management, Enhanced Care Management, Community Support, and Complex Case Management programs. Facilitates timely implementation of hospital discharge plans in collaboration with other interdisciplinary team members; arranges follow-up care as appropriate. Performs home visits to patients meeting complex case management criteria; performs medication reconciliation within the nursing scope of practice. Accompanies patients to provider visits as needed. Meets patients at their home or homeless patients in public areas as needed to facilitate enhanced care coordination services. Collaborates with MSO Utilization Management team and PCPs to ensure resource utilization is appropriate; plans and implements strategies to reduce resource consumption and achieve positive patient outcomes. Identifies community resources and assists patients in applying for the needed services. Participates in the development of policies and procedures to meet program requirements; participates in internal and external meetings and presents relevant information to designated committee. Makes complex clinical decisions regarding medical care; involves medical directors and providers to solve the complex issues. Utilizes multiple systems to maintain documentation of case management activities; collects, analyzes and reports on data for utilization, quality improvement, compliance, and other areas as assigned. Assists in training new NCM and Care Coordinators in the Case Management team to guide them in accurately completing their work and to ensure complete understanding of the NEMS CC/CM program. Performs other job duties as required by manager/supervisor.

Requirements

Bachelor’s degree required.
Valid California Registered Nurse license.
Demonstrate willingness to make decisions within RN's clinical scope of practice; exhibit sound, accurate, and ethical judgment.
Ability to engage and work collaboratively with others, including patients, patient's families, clinical team members, clinical supervisors, and community resources.
Ability to provide detailed, concise note/documentation of work within workflow turn-around timelines.
Basic medical knowledge, including the ability to observe safety and security procedures, and recognize trauma symptoms and behaviors.
Good communication and interpersonal skills; ability to work with people from diverse backgrounds and experiences.
Able to spend 20-40 minutes at a time with patient in the community, including at clinics, specialist offices, hospitals, community-based organizations, or patient's home which may be in understaffed/remote areas, in the presence of pets or family members that are tobacco users.
Valid Driver License and ability to maintain preferred.
Time management and prioritization skills are vital.
Current documentation of Basic Life Support is required.
Must be able to fluently speak, read and write English.
Fluent in Chinese (Cantonese and Mandarin) required.

Nice To Haves

Fluent in other languages is an asset.

Responsibilities

Applies professional clinical skills and expertise in the assessment, planning, implementation, and coordination of necessary healthcare services.
Develops and manages individualized plan of care to assure consistent, timely, and appropriate care is provided in a patient-focused manner; collects data, assesses needs, identifies problems and options, plans appropriately, sets goals, monitors and evaluates progress.
Provides an interdisciplinary process in which healthcare team members collaborate with patients and their families to support quality care and to ensure that patient's care is continuous and integrated among all service providers.
Provides disease management to patients who have certain diseases such as end stage renal disease, cancer, and palliative care.
Manages patients in different case management programs such as the Chronic Care Management, Enhanced Care Management, Community Support, and Complex Case Management programs.
Facilitates timely implementation of hospital discharge plans in collaboration with other interdisciplinary team members; arranges follow-up care as appropriate.
Performs home visits to patients meeting complex case management criteria; performs medication reconciliation within the nursing scope of practice.
Accompanies patients to provider visits as needed.
Meets patients at their home or homeless patients in public areas as needed to facilitate enhanced care coordination services.
Collaborates with MSO Utilization Management team and PCPs to ensure resource utilization is appropriate; plans and implements strategies to reduce resource consumption and achieve positive patient outcomes.
Identifies community resources and assists patients in applying for the needed services.
Participates in the development of policies and procedures to meet program requirements; participates in internal and external meetings and presents relevant information to designated committee.
Makes complex clinical decisions regarding medical care; involves medical directors and providers to solve the complex issues.
Utilizes multiple systems to maintain documentation of case management activities; collects, analyzes and reports on data for utilization, quality improvement, compliance, and other areas as assigned.
Assists in training new NCM and Care Coordinators in the Case Management team to guide them in accurately completing their work and to ensure complete understanding of the NEMS CC/CM program.
Performs other job duties as required by manager/supervisor.