RN Case Manager Team Lead

TruHealth•St. Louis, MO

About The Position

The Registered Nurse Case Manager provides daily management and support for case management strategies and care coordination for patients associated with a Medicare Advantage plan. The role includes managing an assigned patient caseload, conducting health risk assessments, developing and revising plans of care with the health care team, and coordinating patient care and outpatient discharge planning. The RN also educates patients, families, and facility staff; supports managed care audits and improvement projects; researches clinical questions; and resolves day-to-day care coordination issues. The position requires a self-starter and team player who can manage multiple priorities, work with minimal supervision on assigned projects, adapt quickly to change, and collaborate with multiple teams. Work is performed under general supervisory oversight, with substantial independence for assigned work. The position does not have supervisory responsibilities, but it provides training and education to facility staff. Travel is required, and flexible hours, unscheduled overtime, or occasional weekend work may be necessary.

Requirements

Successfully complete required training.
Maintain the established work schedule and handle multiple priorities effectively.
Exercise independent discretion and decision-making.
Have reliable transportation.
Maintain current automobile insurance according to company policy.
Graduate from an accredited Registered Nursing Program.
Have two years of experience in clinical nursing or rehabilitation for the geriatric population.
Have two years of experience in managed care and three to five years of experience performing case management within a managed care environment.
Hold a current state Registered Nursing License.
Hold a current and valid driver’s license.
Communicate and present effectively; collaborate with multiple teams and adapt quickly to change.
Use analytical thinking, sound judgment, accountability, initiative, and ethical behavior, including maintaining HIPAA confidentiality.
Use standard office equipment, Microsoft Suite applications, a desktop, laptop and/or iPad, and standard medical equipment.

Nice To Haves

Bachelor’s degree.

Responsibilities

Manage an assigned patient caseload.
Complete health risk assessments for designated members.
Initiate, reassess, and revise plans of care in collaboration with the health care team.
Evaluate, coordinate, and plan patient care with the interdisciplinary health team.
Educate patients, families, and facility staff according to identified needs, using available teaching resources as needed.
Coordinate outpatient discharge planning according to patient needs, clinical circumstances, and benefit coverage.
Participate in managed care audits and generate, maintain, and track reports and documents supporting the Care Coordination program.
Perform improvement projects, including developing monitoring and collection tools, reviewing medical records, entering and analyzing data, and preparing audit findings and reports.
Participate in patient care conferences, committee meetings, staff development, and educational programs to maintain professional competency.
Apply medical management criteria correctly.
Research clinical questions from employers, members, and payors; educate members about health access options.
Respond to, manage, and resolve day-to-day care coordination issues, communicating effectively with the facility.
Round in patient care delivery areas according to market needs.
Perform other duties as assigned.