Job Description
The Case Manager RN directs the utilization review of patient charts, treatment plans, and discharge planning pertaining to the quality of care and treatment criteria for patients in a specific department.
The Case Manager RN specializes in the review of information pertaining specifically to the assigned areas. Relies on education, experience, professional training and judgment to accomplish responsibilities.
A wide degree of creativity and latitude is expected. Works under minimal supervision.
Responsibilities
Individual High Risk Care Management Assists health plan member to set realistic goals using system tools and judgement.
Gain trust to assure disease based, high risk or high utilization individuals set and meet or exceed targets. Consistently measures and communicates with the individual on goal status and documents progress and measures of improvement using system tools.
Process includes constant communication, psycho-social skills and disease management care plans such as obesity, diabetes and hyperlipidemia.
Coordinates care team around individual to assure obstacles to goals are removed including such activities as making appointments, assuring prescriptions are filled, directing care to physicians, specialists, EAP or other providers.
Uses system tools to monitor, identify, and facilitate in the closing of gaps in care and collaborates with members encouraging compliance in order to achieve health status goals
Provider collaboration Communicates effectively with the provider to assure that the panel of individuals is on track with health goals.
Monitors care plans including outcomes for measurement of disease, wellness and other goals.
Member satisfaction Ensures that services provided to members maintains or improves member health status, optimizes benefits available within health plan, and improves overall patient satisfaction of services delivered
Qualifications
MINIMUM REQUIREMENTS :
Experience : 3 years of general or specialty nursing practice
Education : graduate of an accredited school of nursing
License & Cert : Current Louisiana State RN
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