The purpose of the Case Manager position is to support the physician and interdisciplinary team in facilitating patient care, with the underlying objective of enhancing the quality of clinical outcomes and patient satisfaction while managing the cost of care and providing timely and accurate information to the HMO.
- Assesses member's health status and treatment plan and identifies any gaps or barriers to healthcare.
- Establishes a documented patient centric case management plan involving all appropriate parties (client, physician, providers, employers, etc), identifies anticipated case results/outcomes, criteria for case closure, and promotes communication within all parties involved.
- Provides telephonic support as dictated by client and business needs.
- Provides health education and coaches the client on treatment alternatives to assist them in making informed decisions about healthcare choices.
- Supports clients in selection of best physician and facility to maximize access, quality, and to manage healthcare costs.
- Coordinates services and referrals to health programs. Manages utilization through patient education.
- Assists members in sorting through their benefits and making choices.
- Implements, coordinates, monitors and evaluates the case management plan on an ongoing, appropriate basis:
- Acts as a timely and proactive liaison between health plans, client/family, physician(s) and facilities/agencies
- Maintains accurate record (system) of case management interventions including timely patient contacts, goal progression and required data collection.
- Performs Transition of Care follow up to members post-acute and post ED
- Adheres to professional practice within scope of licensure and certification quality assurance standards and all case management policy and procedures.
- Delivers utilization review services when member is in active case management, as appropriate
- Participates in departmental and corporate training initiatives and demonstrates evidence of continuing education to maintain clinical expertise and certification as appropriate.
- Remains compliant with all accreditation, State and Federal mandates
QUALIFICATIONS/BASIC JOB REQUIREMENTS
- Minimum of 3 years RN experience in an acute care or clinical setting required
- One year of utilization review or case management experience preferred.
- Case Management or CCM certification preferred
- Managed care experience strongly preferred
- Experience working with Medicare, and Medicaid preferred
- EPIC experience required
- Graduate of an accredited school of nursing, Bachelor Degree in nursing
- Current license as a Registered Nurse in the State of Illinois
- Current CPR certification with the American Heart Association or American Red Cross
- 40 hours/week: M-F no weekends, very flexible with schedule
- 8a-4:30p business hours.