Case Manager - Registered Nurse - RN

JOB SUMMARY: Provides Case Management services to a specific clientele. Screens cases for possible case management services according to predetermined criteria. Authorizes inpatient and/or outpatient treatment according to company's stated criteria. Evaluate physician's treatment plan and other records to develop a care plan to assist patient to move as rapidly and cost effectively as possible through health care services. Consults with providers, clients and family members as needed. Documents all initial and concurrent reviews, including, but not limited to diagnosis, symptoms, interventions, goals and plan for next review. Identifies providers for specialized services and negotiate rates when services are provided outside the contracted provider network. Supervises and monitors the duties and responsibilities assigned to the Case Management Assistant.ESSENTIAL DUTIES AND RESPONSIBILITIES: (including, but not limited to the following, as other duties may be assigned).• Contacts patient to assess the patient’s condition, understanding of his/her injury and the patient’s ability to follow the treatment plan. • Contacts members of the medical team to discuss the patient’s course of progress and needs utilizing available discharge information (if there was a hospitalization) and the initial needs assessment. • Initiates and facilitates interdisciplinary team conferences.• Documents activity, assessments and interventions in appropriate modules (Case Management and Electronic Medical Record).• Arranges for all services required coordinating services with the health care team to eliminate duplication of service and conserve health benefit dollars. • Contacts or visits family to ascertain its understanding of the patient’s diagnosis and prognosis and its ability to provide caregiver support. • Checks home for safety factors and architectural barriers and arrange for any modifications. • Identifies problems, anticipates complications and acts to avoid them, providing health instruction to the patient and family and referring the patient back to the physician or other health care team members when appropriate. • Identifies plateaus, improvements, regressions and depressions; counseling accordingly and recommending help. • Makes personal visits or contacts the physician to clarify diagnosis, prognosis, therapies, activities of daily living, etc. • Provides authorizations for any modalities of treatment recommended; investigation and suggesting alternative treatments when appropriate. • Assists with obtaining information and forms regarding living wills, health care proxy, do-not-resuscitate order, etc. • Conducts personal visits to the patient’s home or hospital. • Facilitates transfers of clients throughout the different regions and within the region by collaborating with the liaisons to transition the client with minimal disruption of their health care services. • Coordinates the basic benefit and identifies and submits benefit modifications as appropriate or submits a request for benefit exceptions or special programs. • Educates physicians and appropriate personnel regarding benefits and limitations as well as payment processes. • Collaborates with the physicians, clients/families, and involved providers to evaluate the client needs and ensure clients are receiving adequate services to meet their needs. • Conduct training for other associates regarding the overall Case Management Program and specific processes such as the case management referral process.SUPERVISORY RESPONSIBILITIESThis job has no supervisory responsibilities. For more information about our job opportunities, please visit our website. http://www.maximstaffing.comTo perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill, and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.REQUIREMENTS:• A Bachelors Degree in Nursing (preferred).• Certification as a Case Manager.• RN licensure and three (3) years clinical practice experience and practice case management within the scope of their licensure (based on the standards of the discipline).EDUCATION: Graduate of Nursing program, BSN Degree preferred.CERTIFICATION/LICENSE: - Valid Registered Nurse license - Certified in Case Management (CCM).EXPERIENCE:• 3 years clinical experience in a health care environment. • 2 years proven case management experience required. • TRICARE or managed care experience desirable.KNOWLEDGE, SKILLS & ABILITIES: • Demonstrated ability for assessment, evaluation and interpretation of medical information. • Skilled in the operation of the computer including proficiency in Microsoft Office Word, Excel and Access. • Should have a high level of understanding of community resources, treatment options, home health availability, funding options and special programs.• Preferred knowledge of HIV/AIDS and related issues as they relate to a diverse population.• Bi-lingual preferred.COMPUTER/SOFTWARE SKILLS & ABILITIESTo perform this job successfully, an individual should have knowledge of Word Processing software. Job Title: Case Manager - Registered Nurse - RN Company: Maxim Staffing Solutions--Nurse Staffing Location: US-CA-Los Angeles Status: Employee Job Category: Medical/Health Contact: Dan Gutierrez Email: Apply by Email Address: 4240 Latham St.Riverside,CA 92501 Phone: 951-369-8517 Fax: 951-369-8519 Reference Code: 70033