Nurse Case Manager - Louisville/Lexington, KY

TRIUNE Health Group•Louisville, KY

12d•Hybrid

About The Position

The Nurse Case Manager coordinates resources and creates flexible, cost-effective options for catastrophically or chronically ill or injured individuals to facilitate quality, individualized, holistic treatment goals, including timely return to work when appropriate. This role involves providing medical case management through coordination with patients, physicians, other healthcare providers, employers, and referral sources. The Nurse Case Manager will utilize the steps of Case Management (assessment, planning, implementation, evaluation, and outcome) to manage an individual's progress. They will evaluate treatment plans for appropriateness, medical necessity, and cost-effectiveness, and facilitate care such as negotiating and coordinating durable medical equipment and home health services. The position also includes assessing rehabilitation facilities, facilitating transportation, and coordinating home assessments when required. Clear and compassionate communication with patients and families is essential, as is staying current with medical terminology and relevant federal and state laws (healthcare, Workers’ Compensation, ADA, HIPAA, FMLA, STD, LTD, SSDI, and SSA). The role requires utilizing technology for timely reports, researching medical and community resources, and possessing a valid driver’s license with the ability to travel 90% of the time. Other duties as assigned.

Requirements

Graduate of an accredited school of nursing.
Current RN licensure in the state of operation.
Fluency in English (speaking, reading, and writing).
Three or more years of recent clinical experience, preferably in trauma, psychology, emergency, orthopedics, rehabilitation, occupational health, and neurology.
Proven leadership skills.
Excellent verbal and written communication skills, including the ability to interact effectively with patients, customers, and fellow employees via phone, email, in-person, and formal presentations.
Methodical in accomplishing job-related goals.
Strong analytical and organizational skills, including the ability to multitask with attention to detail.
In-depth knowledge of multi-software packages, notably Microsoft Office Suite (Word, Excel, PowerPoint, Outlook) and the Internet.
Maintain a friendly, professional attitude at all times.
Exercise initiative and be solution-oriented, while keeping management up-to-date on current situations or opportunities.
Dependability and adaptability.

Nice To Haves

CCM preferred.
The state board requires one or more or a combination of the following certifications: CCM, CRC, CRRN, LPC, COHN, COHN-S or CDMS.

Responsibilities

Provide medical case management to individuals through coordination with the patient, physicians, other health care providers, the employer, and the referral source.
Utilize the steps of Case Management to provide assessment, planning, implementation, evaluation, and outcome of an individual’s progress.
Evaluate individual treatment plans for appropriateness, medical necessity, and cost-effectiveness.
Facilitate care, such as negotiating and coordinating the delivery of durable medical equipment and home health services, ensuring clear communication.
Assess rehabilitation facilities for appropriateness of care, facilitate transportation, and coordinate architectural assessments of patients’ homes when required.
Communicate medical information clearly and compassionately to patients and families.
Stay current with medical terminology and the federal and state laws related to health care, Workers’ Compensation, ADA, HIPAA, FMLA, STD, LTD, SSDI, and SSA.
Utilize technology (computer, cell phone, fax, and scanning machine) to prepare organized, timely reports while complying with safety rules and regulations in conjunction with HIPAA.
Research medical and community resources for individuals with catastrophic or chronic diagnoses, such as but not limited to AIDS, cancer, spinal cord injuries, diabetes, head injuries, back injuries, hand injuries, and burns, ensuring accessibility for individuals.
Possess a valid driver’s license with the ability to travel 90% of the time.