Case Manager RN Job in Nashville, Tennessee US

Case Manager RN

Job ID: 2012-18335
# Positions: 1
Location: US-TN-Nashville
Search Category: Nursing
Type: Regular Full-Time

Summary:

The Case Manager RN is responsible for managing members experiencing complex or catastrophic illness, injury and/or specialty illnesses such as diabetes, HIV, transplant, etc, to insure cost effective and efficient utilization of health services. She/he acts as a member advocate, seeking and coordinating creative solutions to member's health care needs without compromising quality of outcomes.

Responsibilities:
- Obtains an accurate member history.
- Assesses clinical information to develop care plans including a member support system.
- Establishes short and long term goals in collaboration with the member that meet the member's needs and the referral source's requirements.
- Establishes working relationships with referral sources and community resources.
- Communicates care objectives to appropriate individuals/departments/referral sources.
- Assessment of biopsychosocial factors.
- Identifies members with potential for high risk complications and coordinates the appropriate treatment in conjunction with the member and the health care team.
- Collaborates with the member's PCP and specialists in the development of the plan of care to ensure that members' physical needs are addressed.
- Provide case management and/or disease management services to members, as identified by the health plan's CI3 list.
- May be required to conduct field visits.
- May be required to perform Pre Certification duties and responsibilities as assigned and required by the Plan.
- Acts as an advocate for an individual's health care needs.
- Reviews benefit systems and cost benefit analysis.
- Evaluates the quality of necessary medical services.
- Utilizes criteria for authorizing appropriate clinical services.
- Identifies members that would benefit from an alternative level of care.
- Acquires data and evaluates necessary health services for cost containment.
- Documents effectiveness of case management services.
- Identifies the need for assistive devices/adaptive equipment needed for members.
- Conducts skills assessment, planning, implementation, coordination, monitoring and evaluation.
- Requests direction from appropriate supervisor(s) on complex issues.
- Utilizes leadership skills for non-clinical team members.
- Collaboratively works with other departments.
- Participates in Quality Improvement processes.
- Serves on internal and external committees.
- Maintains member confidentiality.

Qualifications:

EDUCATION AND EXPERIENCE:

Education

Required:
- Current RN state license required.

Preferred:
- Bachelors or Masters Degree.

Years and Type of Experience Required:

Required:
- Four years experience in health care, case management, discharge planning or behavioral health.

Preferred:
- Experience working on the community level and with community agencies preferred.

Specific Technical Skills

Required:

Preferred:

Certifications or Licensure

Required:
- Must possess a valid driver's license and access to a motor vehicle.

Preferred:
- Certified case managers preferred.

Other

Required:
- Computer literate.
- Excellent verbal and written communications skills.
- Strong decision making skills.
- Ability to provide services in an environment that involves multiple health care systems.
- Ability to interact with all relevant components of the health care system.
- Ability to provide services that deal with the individual's broad spectrum of needs.
- Self-starter with ability to handle multiple projects at one time.
- Appreciation of cultural diversity and sensitivity towards target population.
- Bilingual a plus.

PHYSICAL REQUIREMENTS:
- Must be able to operate a computer.
- Must be able to operate (and communicate via) a telephone.
- Must be able to sit for long periods of time

ermHO