Case Manager Jobs

About The Position

Requirements

• Ability to interact with a wide variety of people and handle complex situations simultaneously with customer service focus.
• Evidence of creativity, integrity and initiative.
• Attention to detail and follow-up.
• Experience with electronic clinical charting/records.
• Ability to work independently and be self-motivated in a remote environment.
• Manage assigned caseload as business needs dictate.
• Excellent time management, flexibility, and efficient organizational skills with ability to work independently and as a team player in both office/remote environment.
• Adherence to legal and ethical principles of privacy, confidentiality, safety, advocacy, and accreditation and regulatory standards in all case management activities in both office/remote environment.
• Compliance to internal and external goals/metrics established for assigned department.
• Position is often required to independently plan and prioritize patient care objectives.
• The ability to analyze and problem-solve.
• Proficient computer skills in Windows, Care Management Platforms, and general Internet use.
• Ability to chart and follow designated workflow(s) in an electronic environment.
• Proficient in typing.
• Strong verbal and written communication skills required to meet superior customer service and satisfaction levels.
• Excellent interpersonal skills and ability to function as a member of a multi-disciplinary team.
• Ability to communicate, read, and write fluently in English.
• Effective analytical and problem-solving skills.
• Advanced Nursing Diploma and/or college degree in nursing required.
• Minimum two years (full-time equivalent) direct clinical care experience required.
• Minimum two years experience with long-term care population.
• Licensed Registered Nurse with current, unrestricted license in state of practice (Georgia) required.
• Current CPR certification.

Nice To Haves

• Bachelors (or higher) degree preferred.
• Minimum three years industry experience in a managed care setting focused on experience in utilization review/case management and at least two years case management, home care or hospice experience strongly preferred.
• Minimum of Class B driver’s license preferred.
• Certified Case Manager preferred – Mandatory to apply for CCM certification when eligible.

Responsibilities

• Conduct in-home and telephonic assessment and data collection with patients and caregivers and document findings in a concise/comprehensive manner.
• Develop a case management care plan for each patient based on a thorough history and clinical record review, including the attending physician’s plan, the recommendations of national guidelines, social supports in place, and in consideration of the patient’s ability to comply.
• Monitor the needs of patients and families on an ongoing basis while facilitating any adjustments to the plan of care as changes are needed.
• Provide care management and coordination to assure that the patient progresses through the continuum of care and utilizes the most clinically appropriate and cost-effective quality resources through the application of national practice guidelines and CM Standards of Practice.
• Coordinate with the Plan Care Navigator/Member Advocate for the integration of the social service/support function into patient care.
• Coordinate the hospital activities concerned with case management and discharge planning.
• Help to assure that the patient has access to a range of choices, coordination of primary care provider (PCP) and specialists, understanding of treatment plan and medications, identification of special needs and referrals, and coordination of transition between care settings.
• Educate the patient and provide emotional support on an ongoing basis related to identified risk factors and a wide variety of topics and empower the patient to take an active role in his/her care.
• Work with pharmacist and patient/caregiver to ensure medication therapy management and compliance.
• Implement case management interventions by the application of methods, techniques, behaviors, information and learning aids that positively impact the patient and their condition.
• Function as an effective liaison between patient, PruittHealth Premier, caregivers, and other community health providers to ensure appropriate clinical oversight and engagement is provided.
• Ensure the scheduling, coordination and completion of the inter-disciplinary team with primary care provider and can also include other members such as social workers, dieticians, pharmacologist, and physician consultants, and other providers as appropriate.
• Organize, secure, integrate and modify the resources necessary to accomplish the goals outlined in the case management plan, utilizing partnership with the other plan staff where appropriate and needed.
• Timely creation of quality case management reports documenting results of CM plan interventions in achieving patient-specific goals.
• Facilitate benefits preservation through coordination of appropriate level of care and plan compliance.
• Facilitate recommended treatments with contracted providers to preserve patient benefits and facilitate cost containment objectives.
• Work closely with participant to facilitate understanding of available client benefits and local resources.
• Adhere to PruittHealth Premier goals, objectives, standards of performance, and policies and procedures.
• Ensure compliance with quality patient care and regulatory compliance within the company’s standards and RN scope of practice.
• Comply with PruittHealth Premier’s confidentiality policy, HIPAA requirements and state and federal regulations.
• Support the highest level of participant-defined quality of life and well-being.
• Identify overall quality improvement activities.
• Business travel may be required.
• Ability to work in triage and/or disease management role if needed.
• Other duties as assigned.