Registered Nurse - Wounded Warrior Case Manager

ERP International•Montgomery, AL

29d•Onsite

About The Position

ERP International is seeking a Registered Nurse (RN), Case Manager for a Full-Time position to support the Wounded Warrior Program of the 42 Medical Group at Maxwell AFB, AL. This role is dedicated primarily to the active duty wounded, ill, and injured (WII) population, but offers flexible capacity to support non-WII patients based on operational demand. The Case Manager will identify individuals with chronic, catastrophic, complex, high utilization, high-risk, or high-cost health issues who would benefit from CM services and notify PCM teams. They will provide CM and/or care coordination, assess patient needs, develop personalized care plans, and facilitate access to necessary healthcare services and community resources. The role also involves providing education to patients and their families, advocating for patient needs, collaborating with PCM teams, providing behavioral health (BH) CM services, and documenting all encounters within the patient’s EHR. Additionally, the Case Manager will maintain a current registry of patients receiving CM services, coordinate with PCM team staff, and provide CM/care coordination training to MTF personnel. Participation in various medical management, population health, quality, and care coordination meetings is also expected.

Requirements

Bachelor’s degree of Nursing.
Graduate from a college or university accredited by Accreditation Commission for Education in Nursing (ACEN), the Commission on Collegiate Nursing Education (CCNE) Incumbent degree may be considered if lower than required.
Minimum of 24 months of full-time experience within the last 60 months working in case management, care coordination, or a related role with significant, direct responsibility for comprehensive client service planning and advocacy.
Current, full, active, and unrestricted license to practice as a Registered Nurse.
Wounded Warrior Case Manager must be certified -OR-certification eligible by the Commission for Case Management (CCM) or American Nurses Credentialing Center (ANCC).
Possess current ARC or AHA BLS Healthcare Provider certification.
Must possess ability to pass a Government background check/security clearance.

Nice To Haves

Prior experience working with military or wounded warriors is highly valued but not required.

Responsibilities

Proactively identify candidates for CM or care coordination services using analytic tools, predictive analytics, and CM registries. Referrals may also come from the PCM/interdisciplinary healthcare team.
Identify individuals with chronic, catastrophic, complex, high utilization, high-risk, or high-cost health issues who would benefit from CM services and notify PCM teams, in accordance with DHA-AI 6025.39.
Provide CM and/or care coordination to these patients: Assess the patients’ needs, develop personalized care plans, and facilitate access to necessary healthcare services and community resources.
Provide education to patients and their families.
Advocate for the patient’s needs to ensure timely and appropriate delivery of care.
Collaborate with PCM teams on CM activities. Provides routine updates and outcome metrics on patients enrolled in CM programs to PCM teams.
Provide behavioral health (BH) CM services and follow-up communications to eligible BH patients, in collaboration with the MTF Behavioral Health Lead, IAW DHA-AI 6025.39.
Document all CM or care coordination encounters within the patient’s EHR using proper coding and data capture IAW MHS coding guidance and DHA AI 6025.39. Document patient interactions, referrals, and care plans to maintain consistency and track progress.
Maintain a current registry of all patients receiving CM services. Coordinate with the PCM team staff members about patients moving into CM care (into the registries) and graduating from primary CM care back to the team (off the registries) and document such in an EHR note.
Provide CM/care coordination training, guidance, and mentoring to MTF personnel who utilize these services in their empaneled patients.
Participate in the MTF Medical Management, Population Healthy, Quality, and care coordination meetings as well as appropriate DHA or network webinars, meetings, or work groups.