RN Case Manager Team Lead

Career Center•Macon, GA

About The Position

Come Grow with Us! TruHealth is a division of American Health Partners, a multifaceted company with operations in multiple states. We own nursing homes, health plans for Medicare beneficiaries living in long-term care facilities, as well as divisions offering psychiatric care, home health, hospice, rehabilitation and specialty pharmacy services. We offer competitive pay, generous benefits and advancement opportunities. We believe in caring for the people that care for patients and have many reward and recognition programs to highlight the awesome and important work our clinicians do each and every day. The RN Case Manager is primarily responsible for the daily management and support of the Case Management strategies for care coordination for a group of members who are associated with a Medicare Advantage plan. Visit (in person and/or telephonic) patients to ensure proper nursing care. Interview or correspond with physicians to correct errors or omissions and to investigate questionable claims. Consult and coordinate with health care team members to assess, plan, implement and evaluate patient care plans. This position requires an individual who is a self-starter and team player, has the ability to manage multiple priorities, work with minimal supervision on assigned projects and activities, and demonstrates excellent communication and presentation skills. This individual must be able to adapt quickly to change and be able to collaborate with multiple teams JOB SUMMARY: The Registered Nurse Case Manager is responsible for providing daily management and support regarding case management strategies for care coordination for patients associated with a Medicare Advantage plan.

Requirements

Successful completion of required training
Maintain established work schedule
Handle multiple priorities effectively
Independent discretion/decision making
Reliable transportation
Current automobile insurance according to company policy

Responsibilities

Manage assigned patient caseload
Complete health risk assessments for designated members
Initiate, reassess and revise plans of care in collaboration with the health care team as appropriate
Evaluate, coordinate, and plan patient care in collaboration with the interdisciplinary health team
Provide education to the patient/family and facility staff in accordance with identified needs utilizing available teaching resources as needed
Coordinate outpatient discharge planning in accordance with patient needs, clinical circumstances and benefit coverage
Participate in all Managed Care related audits; generate, maintain and track reports and documents to support Care Coordination program
Perform improvement projects involving development of monitoring/collection tools, review of medical records, 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; educate members on health access options
Respond, manage, and resolve day-to-day issues presented in care coordination; communicate effectively with the facility
Rounding in patient care delivery areas per market needs.
Other duties as assigned