Population Health RN Inpatient Case Manager (Full Time, Day)

NorthBay Healthcare Corporation • Fairfield, CA

2d • $80 - $97

About The Position

At NorthBay Health the Population Health RN Inpatient Case Manager (PHRNICM) is responsible for providing complex case management (CCM) to diverse groups of high-risk capitated populations. Complex case management is defined as the coordination of care and services for members who need help navigating the healthcare system to facilitate the appropriate delivery of the right care and services at the right place and time. These services are provided utilizing available resources across a continuum of care and in collaboration with members, caregivers, medical home providers, and ancillary health care providers. NBH utilizes a Population Health approach to identify diverse groups and to enhance member engagement and coordinate care delivery across populations to improve clinical outcomes. In addition to continuum of care responsibilities this position will assist within the inpatient case management department as needed. At NorthBay Health, our vision is to be the trusted healthcare partner of choice for the communities we serve. We are dedicated to improving the well-being of our community by providing accessible, high-quality care to all who need it. Every member of our team plays a vital role in delivering compassionate and effective healthcare solutions. We invite you to join us in our mission to ensure that every patient and family member feels valued, respected, and cared for throughout their healthcare journey.

Requirements

• Graduated from an accredited nursing school or college.
• BSN required.
• Current California State RN License required.
• Minimum of (2) two years relevant clinical experience required.
• Minimum (1) one year case management experience required; equivalent case management education and/or experience will be considered.
• Knowledge of personal computer with experience entering and retrieving data and MS Suite software specifically MS Word processing and/or good keyboard skills required.
• Ability to effectively communicate with all levels of patients, physicians, health care personnel, supervisory staff, and peers.
• Demonstrates the exceptional ability to be organized and efficient in prioritizing and managing assignments with minimal oversight and direction.
• Demonstrates the willingness to research, learn, and obtain knowledge for the performance of the position.
• Demonstrates a courteous, professional demeanor at all times either working individually or in a team environment working collaboratively in an effective manner maintaining positive relationships with peers and supervisors alike.
• Utilizes critical thinking, and applies sound clinical judgment and assessment skills for decision making.
• Demonstrates the True North values. The True North values are a set of value-based behaviors that are to be consistently demonstrated and role modeled by all employees that work at NorthBay Health. The True North values principles consist of Nurture/Care, Own It, Respect Relationships, Build Trust and Hardwire Excellence.
• Knowledge of: NCQA, DHS, CMS, JCAHO and EMTALA standards and federal and state regulations.
• Acute care, home care, subacute care, long-term care, hospice interventions, rehabilitation options, other community resources and requirements.
• Millimann, Interqual medical necessity guidelines.
• Expert knowledge of CPT and HCPC codes and related guidelines.
• Expert knowledge of ICE guidelines governing TAT, claims and the denial process.
• Current standards and trends in health care, best practices, management tools, and familiarity with related resources and literature.
• Capitiation and Managed Care legislation.

Nice To Haves

• Masters prepared in nursing or other health related field preferred.
• Certified Case Manager (CCM) or Accredited Case Manager (ACM) within (2) two years of starting the position.

Responsibilities

• Identify patients who are considered high risk for medical care resource utilization by reviewing information from referrals placed in the electronic health record (EHR). Referrals may also come through ED, Pharmacy, Hospital, and other departmental or systems reporting.
• Conducts assessments to identify the member’s needs and develops a specific care plan to address objectives, barriers, and goals identified during the assessment.
• Comprehensively identify strengths and opportunities for patients, including physical, behavioral and social support system capacities and degree of engagement with providers.
• Follow-up with patients and providers on identified health care needs and identify possible resources to address those concerns and/or work with care management team to address concerns in a multi-disciplinary method.
• Facilitate and manage referrals from referral specialist, providers, and other care management staff to ensure that identified red flags and healthcare needs of patients are addressed.
• Provide individual consults to patients on health education issues.
• Develop the health awareness of individuals, as well as groups and organizations, empowering them to make better health choices.
• Provide specialized oversight, implementation of care plans, and education to patients while exercising discretion and independent judgment; following established policies and procedures.
• Other duties as assigned to meet the needs of the population managed.

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level
• Number of Employees: 1,001-5,000 employees