RN Case Manager Team Lead

Career Center•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 manages an assigned patient caseload, conducts health risk assessments, and initiates, reassesses, and revises plans of care in collaboration with the healthcare team. It also involves patient and family education, outpatient discharge planning, clinical research, and responding to day-to-day care-coordination issues. The position requires a self-starter and team player who can manage multiple priorities, work with minimal supervision, adapt to change, and collaborate with multiple teams. The role operates under general supervision, with assignments expected to be carried through to completion with substantial independence. It has no supervisory responsibilities, but provides training and education to facility staff. Work is typically performed in a standard office environment, with travel required and possible flexible hours, unscheduled overtime, and occasional weekend work.

Requirements

Graduate from an accredited Registered Nursing Program.
Two years of experience in clinical nursing or rehabilitation for the geriatric population.
Two years of experience in managed care.
Three to five years of experience performing case management within a managed-care environment.
Current state Registered Nursing license.
Current and valid driver’s license.
Current motor vehicle insurance according to company policy.
Successful completion of required training.
Reliable transportation.
Ability to exercise independent discretion and decision-making.
Ability to manage multiple priorities effectively.
Good audio-visual ability and hearing.
Ability to lift up to 40 pounds and to stand, walk, sit, bend, reach, kneel, push, and pull.
Excellent communication and presentation skills; ability to collaborate with multiple teams and work with minimal supervision.

Nice To Haves

Bachelor’s degree preferred.

Responsibilities

Manage an assigned patient caseload.
Complete health risk assessments for designated members.
Initiate, reassess, and revise plans of care in collaboration with the healthcare team as appropriate.
Evaluate, coordinate, and plan patient care in collaboration 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 in accordance with 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 involving development of monitoring and collection tools, medical-record review, data entry, analysis, and preparation of 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 as required, and educate members on health access options.
Respond to, manage, and resolve day-to-day care-coordination issues; communicate effectively with the facility.
Round in patient care delivery areas according to market needs.
Perform other duties as assigned.
Maintain the established work schedule and handle multiple priorities effectively.
Follow safety rules, report unsafe conditions or behaviors, and take reasonable steps to prevent unsafe practices.