Nurse Case Manager (Remote)

2017-1259
US-Remote
Category
Public Health
Type
Regular Full Time

Overview

Karna, LLC is seeking Nurse Care Managers for upcoming remote opportunities with our HHS client. The Nurse Care Manager will identify individuals which may benefit from case management services, evaluate clinical and psychosocial needs, develop a plan of care to address coordination and delivery of care services, educate the patient (significant other) in health and health delivery areas, evaluate established plan of interventions, collaborate with care providers in an ongoing treatment plan and track outcomes. 

Responsibilities

Job Responsibilities

  • Review authorization activity and claim reports recommending placement in case management as indicated by comprehensive assessment
  • Respond to requests from Clinical Centers of Excellence providers to evaluate individuals for the case management program
  • Develop plan of care in conjunction with the patient's significant other, provider and payer
  • Implement plan of care for individuals in inpatient, home, rehabilitation, and/or skilled nursing settings
  • Transition patients to appropriate level of care coordinating services to meet care needs and obtaining vocational or psychosocial assessments as well as physical requirements to plan and implement plan of care
  • Educate the patient on condition, health care system
  • Function as patient advocate
  • Coordinate services to avoid duplication and provide integration of care plan components
  • Monitor ongoing care, satisfaction with care providers, and movement toward goals through interaction with patient, significant others, providers, and payer
  • Interact with the patient and/or designated significant other on a minimum of a monthly basis for evaluation, continued assessment and coordination of care
  • Create reports for client to indicate cost benefit of case management services
  • Maintain awareness of community resources and other resource availability for services outside or complementary to benefit structure. Integrates community resources to implementation of plan where possible
  • Actively involved in internal department procedures and internal quality management program (clinical and operational quality)
  • Review plan of services established for patient for effectiveness and appropriateness of care and satisfaction with services
  • Solicit feedback from providers and patients on satisfaction with case management services
  • Research clinical criteria as indicated
  • Evaluate outcomes as a result of utilizing health status surveys with members as well as through satisfaction questionnaires
  • Communicate with providers for establishing plan of care, obtain clinical updates and coordinate referrals and pre-authorizations when indicated
  • Collaborate with other departments and serves as a liaison to improve communication and customer service
  • Collaborate with other departments within the organization

Qualifications

  • BSN from accredited university
  • Active RN license 
  • Training and/or experience in Utilization, Case or Quality Management 
  • 1-3 years’ experience in hospital or other clinical setting
  • Experience with oncology and/or complex case management preferred 
  • Excellent communication and problem-solving skills
  • Advanced MS Office skills
  • Certification of Case Management (CCM) preferred 

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