Case Manager - Rn

Description

Key Responsibilities

• Perform data entry and maintain complete and detailed documentation of case managed patient in the computer system; maintain site specific logs and files, ensuring confidentiality according to company policy and HIPAA.
• Develop treatment plan in collaboration with the patient, caregivers or family, community resources and multidisciplinary healthcare providers that include obtainable short and long term goals. Monitor interventions and evaluate the effectiveness of the treatment plan in a timely manner; report measurable outcomes that record effectiveness of interventions.
• Telephonically manage cases on a long or short-term basis per established company guidelines, policies and procedures, as well as other standardized criteria in the healthcare industry.
• Advocate for the patient by facilitating the delivery of quality patient care, and by assisting in reducing overall costs; provide patient/family with emotional support and guidance.
• Coordinate care and services and develop patient treatment plans for catastrophic cases.
• Contact patient and complete a thorough assessment, including physical, psychosocial, emotional, spiritual, environmental, and financial needs.
• Initiate and maintain contact with the patient/family, provider, employer group, and multidisciplinary team as needed through the continuum of care.
• Negotiate and implement cost management strategies to affect quality outcomes and reflect this data in monthly case management reviews and cost avoidance reports.
• Meet daily productivity requirement.

Skills, Knowledge & Expertise

• Computer proficiency and working knowledge of Microsoft Office Suite and Microsoft Outlook required.
• 1+ years of case management experience required.
• Current unrestricted RN license to practice in the state of California.
• Knowledge of utilization management/quality management case philosophies and reporting requirements; quality improvement methodologies preferred.
• Knowledge of medical claims and ICD-10, CPT, HCPCS coding preferred.

Benefits

• Paid Time Off policies to support a healthy work-life environment
• Full offering of health and wellness benefits for you and your family
• 401K with company matching
• Competitive pay with opportunity for Career Advancement
• Employee discounts and wellness programs
• Company paid life insurance and disability plan

About HealthComp