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Care Manager RN

Company: Crozer-Keystone Health System
Location: Springfield
Posted on: June 12, 2021

Job Description:

Job Summary: The Care Manager performs care management within the scope of licensure for members with complex and chronic care needs by assessing, developing, implementing, coordinating, monitoring, and evaluating care plans designed to optimize member health care across the care continuum and ensuring member access to services appropriate to their health needs. # Essential Duties Identifies appropriate members for case management and conducts assessments to identify individual needs and a specific care management plan to address objectives and goals as identified during assessment. Implements care plan by facilitating authorizations/referrals as appropriate within benefits structure or through extra-contractual arrangements. Coordinates internal and external resources to meet identified needs of the member. Case Manager to contact each case managed patient, at a minimum, once a month and coordinate care or on an as needed basis.# 20 member contacts required daily.# Update caseload, care plans, reporting as required by department policy Create patient record in HealtheCare system and chart file for each case managed patient with appropriate documentation, authorizations and contact information, including care plan, assessment, progress notes, etc. Monitors and evaluate effectiveness of the care management plan and modifies as necessary to meet NCQA requirements to include all required elements. Interfaces with Medical Director as needed and attends weekly case management rounds. Conducts outbound calls to assign high risk or chronic case managed members. Aids the member in solving issues such as transportation, social problems, referrals, resources, etc. Work with member#s family and physician to coordinate care. Educates member on compliance with physician, health educator, setting short and long term goals. # Qualification Requirements: To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. This job description reflects management#s assignment of essential functions; it does not prescribe or restrict the tasks that may be assigned.# The requirements listed below are representative of the knowledge, skill, and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. # Education/Experience:# RN unrestricted active license required in State of PA At least 2 years# experience in case management preferably in a medical group or health plan setting. Strong clinical background must be familiar with developing care plans and assessments. # Knowledge/Skills/Abilities: Ability to maintain a minimum case load of 150 cases. Able to act independently and make independent decisions. A solid ability to prioritize and multi-task. Excellent communication skills. Able to type a minimum of 40 wpm. Basic computer skills necessary for inputting clinical data Maintain courteous professional attitude when working with internal and external customers. Maintains member confidence and protects operations by keeping claim information confidential in compliance with HIPAA requirements. # # #

Job Summary: The Care Manager performs care management within the scope of licensure for members with complex and chronic care needs by assessing, developing, implementing, coordinating, monitoring, and evaluating care plans designed to optimize member health care across the care continuum and ensuring member access to services appropriate to their health needs.

Essential Duties

  • Identifies appropriate members for case management and conducts assessments to identify individual needs and a specific care management plan to address objectives and goals as identified during assessment.
  • Implements care plan by facilitating authorizations/referrals as appropriate within benefits structure or through extra-contractual arrangements. Coordinates internal and external resources to meet identified needs of the member.
  • Case Manager to contact each case managed patient, at a minimum, once a month and coordinate care or on an as needed basis. 20 member contacts required daily. Update caseload, care plans, reporting as required by department policy
  • Create patient record in HealtheCare system and chart file for each case managed patient with appropriate documentation, authorizations and contact information, including care plan, assessment, progress notes, etc.
  • Monitors and evaluate effectiveness of the care management plan and modifies as necessary to meet NCQA requirements to include all required elements.
  • Interfaces with Medical Director as needed and attends weekly case management rounds.
  • Conducts outbound calls to assign high risk or chronic case managed members.
  • Aids the member in solving issues such as transportation, social problems, referrals, resources, etc.
  • Work with member's family and physician to coordinate care.
  • Educates member on compliance with physician, health educator, setting short and long term goals.

Qualification Requirements:

To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. This job description reflects management's assignment of essential functions; it does not prescribe or restrict the tasks that may be assigned. The requirements listed below are representative of the knowledge, skill, and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

Education/Experience:

RN unrestricted active license required in State of PA

At least 2 years' experience in case management preferably in a medical group or health plan setting.

Strong clinical background must be familiar with developing care plans and assessments.

Knowledge/Skills/Abilities:

Ability to maintain a minimum case load of 150 cases.

Able to act independently and make independent decisions.

A solid ability to prioritize and multi-task.

Excellent communication skills.

Able to type a minimum of 40 wpm.

Basic computer skills necessary for inputting clinical data

Maintain courteous professional attitude when working with internal and external customers.

Maintains member confidence and protects operations by keeping claim information confidential in compliance with HIPAA requirements.

Keywords: Crozer-Keystone Health System, Philadelphia , Care Manager RN, Other , Springfield, Pennsylvania

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