Job Description

Under general direction of the Associate Director of Case Management, identifies, screens, tracks, monitors and coordinates care to ensure highest quality care for client's disease state. Utilizes clinical skills to review and monitor utilization of health care services with the goal of maintaining high quality cost-effective care while engaging and empowering the client. The RN Case Manager will serve as the lead for each multidisciplinary CM team in assessment of medical and social needs for the member. The RN Case Manager will appropriately assign and delegate non-medical CM tasks to the social worker or Community Health Worker for timely follow up and navigation. The RN Case Manager will work in conjunction with Social Workers, Community Health Workers, Physicians, Advanced Practice Providers, and other care team members to provide case management and navigation services, while working in collaboration with inpatient care teams and other Central Health medical and transitions of care teams.

This is an onsite position. Only candidates that live or will live in the Austin area will be considered for this role.

Responsibilities

Essential Functions:

• Knowledge of Utilization Management and application of Medical Necessity criteria.
• Collaborates with the patient’s care team including primary care team, specialists, home care, hospital team, and any others involved with the patient’s care to optimize clinical outcomes.
• Oversees assigned team and assists with establishing work assignments.
• Assesses the physical, social, and emotional needs of patients and families for optimal health outcomes.
• Educates patient and family members on diagnosis, treatments, procedures, medications and healthcare services covered by Central Health.
• Develops, collaborate and execute care plan in collaboration with primary care provider teams through Care at Home Model.
• Performs comprehensive assessment of medical needs, including but not limited to disease education and medication reconciliation.
• Completes all clinical documentation in timely manner, including admissions, resumptions of care, accurately and ensures that documentation meets all requirements per departmental policies and procedures.
• Promote adherence with disease specific clinical outcomes by providing each individual with self-management supports including disease specific education materials and Care plan and treatment goals including self-management goals.
• Responsible for telephonic and/or face to face assessment, planning, implementing, and coordinating all case management activities with members to evaluate the medical needs of the member to facilitate the member’s overall wellness.
• Coordinate care and communication between multiple providers, medical, nursing, social, and behavioral health.
• Evaluate and modify care plan goals based on patient improvement and resource effectiveness.
• Participate in the identification of patient needs for referral to resources that facilitate the continuity of care.
• Serve as a preceptor for new clinical team members and students.
• Participates in continuous quality improvement projects in order to better serve the patient, family and healthcare system to improve the quality of service provided.
• Plan and coordinate care daily with all members of Central Health’s care team to assure maximum quality and efficiency of care between Eligible Patients, Physicians, Advanced Practice Providers, case management and nursing
• Supports organizational initiatives to promote and maintain a strong positive workplace culture.
• Adheres to state board of nursing and state nurse practice act requirements and to other governing agency regulations.
• Performs other duties as assigned.

Knowledge, Skills and Abilities:

• Ability to thrive in a complex and dynamic work environment with multidisciplinary, cross-functional teams and matrixed team structures.
• Ability to apply critical thinking to generate and assess potential solutions and to anticipate needs in advance.
• Knowledge of nursing best practice and industry standards for practice of nursing.
• Compliance with data confidentiality and security procedures
• Ability to interact with colleagues in a respectful, supportive fashion which encourages employee's personal and professional growth
• High level skill at building relationships within the organization and with external partners
• Able to balance a customer-oriented and results-driven approach
• Able to persuade others to approach topics and ideas with an opportunistic mindset
• Strong attention to detail and accuracy
• Ability to communicate complex ideas clearly and effectively through both writing and speaking
• Experience with electronic medical records and healthcare-derived data and working knowledge of the laws and regulations that govern the same.
• Ability to collaborate with patients, families and care teams through multiple complex systems
• Strong assessment skills
• Follows standard precautions
• Maintains confidentiality
• Exhibit compassion, vulnerability, and empathy when working with employees (patients) and advancing Central Health's equity and DEI goals
• Provide patient centered care that is inclusive and focuses on cultural humility

Qualifications

Minimum Requirements for role:

Education:

Graduation from an accredited School of Nursing

Work Experience:

Minimum three years of clinical nursing experience in a hospital or clinic setting

Licenses/Certifications:

Current unrestricted RN license to practice nursing in the State of Texas

Basic Life Support (BLS) - Obtained through approved American Heart Association Training Network or American Red Cross.