Case Manager 2 - (Us) - Case Mgr Vbqp

PURPOSE AND SCOPE:

Supports all programs within the Value Based Quality Case Management Department and their specific program missions, visions, and customer service philosophy. The Case Manager will promote and support the use of Continuous Quality Improvement (CQI) principles, methods, and tools to improve processes within the department and the organization, and provide guidance, and education in collaboration with the VBQ leadership team and other internal departments to enhance operational processes and case management program outcomes and reduce company risk.

PRINCIPALDUTIES AND RESPONSIBILITIES:

• Implements payor specific quality goals and action plans, in order to achieve standards
• Educates and advances the use of quality improvement tools to ensure adherence to CQI activities.
• Ensures the use of data, benchmarking, and graphical representations in performance improvement activities. Analyzes, manages, and reports data as needed to identify improvement opportunities and measure the progress of improvement projects. Promotes and facilitates the implementation and integration of quality improvement activities within Value Based Quality department.
• Responsible for telephonic Case Management to promote optimal patient outcomes related Vascular Access, Hospitalizations, Dialysis Adequacy and other ad hoc quality measures.
• Other duties as assigned.
• Identify risk areas and opportunities for improvement, and
• Assist with root cause analyses.
• Supports quality improvement program goals directed at improvements in patient health status outcomes, policy and procedures, and established business strategies.
• Demonstrates a strong communication process with Clinical Managers, Hospitals, Physicians, direct patient care staff, and all support staff at the facility.
• Assures effective collaboration, communication and coordination with FKC Quality teams regarding specific action plans for assigned patients not achieving an eKt/V of 1.2.
• Promotes the use of effective demonstrated practices and collaboration throughout all case management programs sharing processes, procedures, and formulas for success. Mentors and assists other case managers in identifying effective practices applicable to their needs, in testing for desired results, and the adoption and implementation of these practices.

• Collaborates with the VP of Value Based Quality Programs to:

  • Set and achieve improved departmental processes, practices, and operational outcomes.

  • Identify risk areas and opportunities for improvement, and

  • Assist with root cause analyses.

• Promotes the provision of quality patient care through immediate medication reconciliation and chart review post hospitalization to assure timely intervention and high quality outcomes for assigned patients.
• Promotes utilization of CQI principles to increase customer and staff satisfaction, and provide overall improved organizational performance.
• Maintains and utilizes current knowledge regarding industry best practices and CMS mandates to evaluate, identify, and recommend systems and practices that would enhance and improve department processes and outcomes.
• Promotes the provision of quality patient care and optimal customer support for the patient population through routine effective infection, lab, missed treatment, UFR and post weight surveillance, medication reconciliation, and telephonic case management skills to ensure achievement of timely intervention and high quality service outcomes for assigned patients.
• Assures adherence to all HIPAA regulatory requirements, including, but not limited to telephonic conversations.
• Promotes, advances, and assists with implementation of FMS clinical, educational and quality initiatives as they relate to the case management department.
• Utilizes effective telephonic case management skills to maximize patient engagement and compliance.
• Effectively communicate, collaborate and coordinate with Vascular Access Case Manager to assure high quality outcomes for assigned patients.
• Set and achieve improved departmental processes, practices, and operational outcomes.

Additional responsibilities may include focus on one or more departments or locations. See applicable addendum for department or location specific functions.

PHYSICAL DEMANDS AND WORKINGCONDITIONS:

• Some travel is required.

• The physical demands and work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

  • The demands include but are not limited to being able to sit at a desk for several hours a day, which includes telephonic work and/or attending required meetings. Day-to-day work includes desk and personal computer work.

• The demands include but are not limited to being able to sit at a desk for several hours a day, which includes telephonic work and/or attending required meetings. Day-to-day work includes desk and personal computer work.

EDUCATION:

• BSN required with active unrestricted nursing licensure in practicing state - with the ability to obtain licensure in multiple states.

EXPERIENCEAND REQUIRED SKILLS:

• A fundamental knowledge of managed care a plus.
• Computer proficiencies: Microsoft Excel and/or Access, PowerPoint, Word, Lotus Notes, or other e-mail provider.
• Must complete the required compliance and FMCNA orientation and training modules and attend ongoing training and development programs within the specified time line.
• Good organizational skills with ability to prioritize appropriately.
• Excellent verbal and written communication skills.
• Excellent skills in customer service, relationship development, results orientation, team building, motivating employees, and decision-making.
• 1 year of case management experience required.
• Working knowledge of CQI (Continuous quality improvement) principles.
• Demonstrated skills in diversity management and performance management.
• Must have working knowledge of the reimbursement and insurance verification process.
• Certification in case management required.
• 2 - 5 years' of Clinical Nephrology Nursing; or equivalent directly related work experience.

EO/AA Employer: Minorities/Females/Veterans/Disability/Sexual Orientation/Gender Identity

Fresenius Medical Care North America maintains a drug-free workplace in accordance with applicable federal and state laws.