Case Manager,Behavioral Health RN
RN Nurse Case Manager Band 3 ( Physical and Behavioral Health)
Under general supervision of the Manager DM, the RN Nurse case manager is responsible for providing wellness coaching to assigned members through telephonic and face to face assessments, identifies barriers to care, develops a person centered care plan, conducts self-management education, and care coordination and refers to appropriate community services and healthplan benefits to minimize barriers to care .
The RN case manager will use techniques such as motivational interviewing, behavior change, and cognitive behavior techniques to help assigned members achieve optimal health and well-being.
The RN Nurse case manager will support members working in conjunction with an existing team of Health professionals. The RN Nurse case manager will assist in identifying and assessing high risk patients identification of problems and barriers to care including chronic care self-care skills educational needs and for coordinating the delivery of cost-effective, quality-based health care services for health plan members by development and implementation of individualized treatment plans addressing individual needs of the member, their benefit plan, and community resources.
Case Manager Primary Duties & Responsibilities
1. Conducts Telephonic and face-to-face outreach and coaching to members to bring about lifestyle behavior changes to improve health status, reduce health risks and improve quality of life and clinical outcomes.
2. Effectively manages a case load of 60 - 100 members and conducts outreach based on risk level and departmental policies.
3. Completes documentation within 24 hours of outreaches per departmental policies and utilizes approved documentation templates.
4. Assists in the identification of member health education needs and monitors current clinical status by conducting assessments using approved assessment tools.
5. Utilizes approved chronic care and prevention guidelines and general health and wellness strategies to achieve goals in the overall health of members.
6. Assesses the member's readiness to change and implements actions to assist members in moving through stages of change to reach their goals.
7. Works with members to identify and set personalized health improvement plans and goals and support members in achieving those goals.
8. Collaborates with team members such as Clinical pharmacist, Service coordinators, Medical Director, ancillary service providers and member's medical home provider and treating specialist as well as other case managers.
9. Works with members on opportunities to close gaps of care and to improve their overall health status
10. Empowers members with skills to provide enhanced interaction with their treating physicians
11. Collaborates with hospitals discharge case managers to facilitate effective communication for discharge planning and transitions of care for the purposes of assisting with community resources, DME providers, referrals, housing and other related duties. Conducts post discharge assessments in person for high risk members in accordance with policy.
12. Identifies barriers to care and intervenes appropriately to lessen or eliminate the barriers to care.
13. Collaborates with the member/family, physician, and health care providers/suppliers to discuss and prioritize the plan of care and prescribed treatment plan in accordance with evidenced based medicine and identified long and short term goals
14. Conducts on-site or in-home face to face evaluations as requested by the member/caregiver, as determined per assessment of the member or when progress is not being made in achieving goals
15. Develops, monitors, and evaluates the plan of care, extends, revises or closes the plan of care according to Interdisciplinary care team recommendations and communicates case management decisions
16. Performs research on relevant topics in health promotion and disease prevention, as required for specific members
17. Consults with and assist team members in cases where a member's behavioral health or emotional issues are impacting their ability to set and/or achieve goals
18. Understands and follows policies and procedures, completes documentation of interactions and interventions of assigned members in the QNXT case record or other systems as it applies, produces and submit reports in a timely manner and in accordance with workflows and policies
19. May actively participate in committees as assigned and act as Team Lead as assigned
20. Actively participates in interdisciplinary care teams; assures appropriate documentation in QNXT and defined care plans are completed
21. Acts as a preceptor for new employees as assigned
22. Perform other related duties incidental to the work described herein
Minimum Requirements: Current licensure as a Registered Nurse (RN) in applicable state or active license in a state allowing "multistate privilege to practice". Three or more years of clinical experience and two or more years of experience in case management. One year of BH experience as a case manager or clinical position. Proficiency in Microsoft Office. Experience in Health education and coaching. Experience with direct member communication (written or verbal). Working knowledge of motivational strategies.
Preferred Requirements: Certified Case Manager. Previous STAR+PLUS Medicaid experience. Prior experience working with community resource organizations. Five or more years' experience in clinical and case management or in Managed Care. Experience in telephonic counseling/coaching preferred. Excellent interpersonal skills and the ability to work in a team environment. Bilingual English-Spanish Highly Preferred. Must be able to sit and work on a computer for the majority of the work day when not doing home visits.
Unrestricted driver's license and reliable mode of transportation. Conducts home, community and hospital and or physician office visits as needed to coordinate care and provide self-care education and monitoring of signs and symptoms. Home and community visits are up to 50% of the work time.
Equal Opportunity Employer: Race, Color, Religion, Sex, Sexual Orientation, Gender Identity, National Origin, Age, Genetic Information, Disability, Protected Veteran Status, or any other legally protected group status.