RN Case Manager

HealthPartnes is hiring an RN Case Manager. This position exists to provide support to patients their families and physicians in addressing medical and social concerns; educate and empower patients and families to make informed personal health care decisions; and facilitate communication between patient physician health plan and community.

ACCOUNTABILITIES:

• Member Focus

  • Ensures all activities are member-focused and individualized resulting in personalized attention to each patients unique needs.

  • Identifies interventions and resources to assist member reaching personal health related goals.

  • Identifies patterns and episodes of care that are predictive of future needs and services.

• Integration

  • Integrates clinical and psychosocial information for case identification and individual patient assessment to develop action-oriented and time-specific planning and implementation of appropriate interventions.

  • Facilitates integration of patient care by encouragement of effective communications between patients families providers health plan and care system programs and community-based services.

  • Adheres to department policy and procedure in daily activities.

  • Coordinates service coverage with appropriate funding sources when indicated.

  • Works with Supervisor Case Management Government Programs department and Member Services department to ensure compliance with Medicare requirements and regulations.

• Communication

  • Effectively communicates with patients and their families to provide them with a better understanding of their health health care benefits and health care system.

  • Effectively and routinely communicates with patients families physicians and health care team members to facilitate successful collaboration resulting in high levels of member/patient/family/provider satisfaction.

  • Provides educational information and materials to members to support preference sensitive decisions.

  • Provides regular reporting of member outcomes to Case Management leadership according to defined process.

  • Identifies and promptly reports potentially adverse situations to leadership as outlined in department policy and procedure.

  • Identifies and promptly reports high cost cases for reinsurance.

  • Maintains current and accurate documentation and case management files in accordance with Case Management policy and procedure.

  • Maintains confidentiality of information in accordance with department and corporate policies.

• Relationships and Team Building

  • Establishes and maintains good working relationships within the Case Management department with other HealthPartners departments and with other health team participants.

  • Supports other team members in achieving patient centered goals.

  • Assists supervisor in maintaining a cohesive Case Management team by contributing to a collaborative respectful and diverse environment.

  • Participates in and contributes to appropriate departmental and/or organizational meetings.

• Technology

  • Maintains knowledge of and effectively uses automated applications and systems.

  • Identifies deficits in technological literacy and seeks appropriate training under guidance of supervisor.

  • Maintains maximum individual productivity through proficient use of automated systems.

• Personal Development

  • Participates in ongoing independent study and education-related professional activities to maintain and increase knowledge in the areas of Case Management patient care services and benefit packages for development of effective case management skills.

  • Demonstrates responsiveness to and appreciation of constructive feedback and recommendations for personal growth and development.

  • Maintains current active Minnesota nursing licensure.

  • May maintain current active nursing licensure in other states as assigned.

• Other Duties

  • Willingly participates in various committees task forces projects and quality improvement teams as needed and assigned.

  • Performs other duties as assigned.
    

CURRENT DIMENSION:

• Directly reports to Supervisor Case Management.

• Directly manages caseload with anticipation of up to 85 members with complex needs.

• Interacts with medical administrative and front line staff within and outside the organization in order to collaborate on members care.

REQUIRED QUALIFICATIONS:

• Registered Nurse with current unrestricted license in the State of Minnesota BSN preferred. License free of history of restrictions and/or sanctions in the past 10 years in all states with current or past licensure.

• Minimum of 3 years clinical practice experience in an acute care setting; minimum of 3 years relevant utilization review discharge planning or case management experience; and current clinical knowledge.

• Demonstrated effective independent nursing judgment and skills.

• Demonstrated skill and experience in effectively collaborating with care team members using a high level of expertise in written oral and interpersonal communication.

• Demonstrated working knowledge of quality improvement utilization management benefit plans fiscal management and various payment methodologies preferred. Understanding of healthcare and/or HMO industry.

• Demonstrated skill in effective use and management of automated medical management systems.

• Demonstrated flexibility organization and appropriate decision-making under challenging situations.

• Basic computer skills

CHALLENGES:

• Maintaining member focus in a rapidly evolving environment.

• Influencing team members and colleagues to work collaboratively in achieving the goals and objectives of the Case Management Program.

• Contributing a positive team building approach as a member of the Case Management team and a global member of the Case Management Department.

DECISION-MAKING:

• Makes independent decisions within the scope of this positions accountabilities and determines the need for and the timing of consultation with Case Management leadership and/or Medical Director.

• Uses professional clinical judgment organizational knowledge industry knowledge and common sense in determining appropriate alternatives for members/patients/families consulting with leadership and/or Medical Director when indicated.

• Makes recommendations to leadership regarding policy development needs and/or changes.