RN CASE MANAGER

PERFORMANCE BASED WORK STATEMENT

REGISTERED NURSE CASE MANAGERS

 

 

 

DESCRIPTION OF WORK

 

·  (1) Full Time Equivalent (FTE) registered nurse case manager for Reynolds Army Community Hospital, (hereafter referred to as the “MTF”, Fort Sill, Oklahoma.

 

 QUALIFICATIONS

 

· Have sufficient experiences to be able to adequately perform the tasks identified, but not limited to, those listed in this work statement.  Registered Nurses shall possess the following:

 

Registered Nurses shall possess the following:

 

· Have a minimum of three (3) years experience in an acute care setting, preferably includes experience with a diverse range of patient age groups. 

 

· Have a current active unencumbered Registered Nursing license from any state or territory of the United States.

 

· Shall possess or obtain national certification in case management as accepted by the URAC Case Management Standards within two years of employment under this contract. The government will not reimburse for these costs.

 

· Have and maintain current certification in Basic Life Support (BLS) or cardiopulmonary resuscitation (CPR) by way of an American Heart Association or Red Cross approved training program. 

 

· Have a minimum of one (1) year managed care and/or medical management (utilization management, case management, disease management) experience.

 

· The contract nurse shall be able to use computer systems and software (i.e., spreadsheets, charts, tables, word processing, E-Mail, etc.) provided by the government. 

 

· The government shall provide training in the Composite Health Care System (CHCS) and other hospital computer information systems that the medical activity’s staff is required to use.

 

· Shall read, understand, speak, and write English fluently.  Demonstrate an ability to express self in all areas of communication, effective listening, and questioning techniques.  Shall have the skill to deal with the public while maintaining tact, a positive approach, and confidentiality.

 

· Shall have experience in program planning, implementation, and evaluation, and in conducting individual, family, group, and community assessments. 

 

· Shall have knowledge of accreditation standards, privacy and confidentiality requirements, such as but not limited to, JCAHO and HIPAA.

 

· Shall have knowledge of coding of healthcare data (i.e., ICD-9, E&M, CPT, etc.)

 

· Shall have a working knowledge of established screening criteria such as Milliman & Robertson and InterQual. 

 

· One or Two Case Managers.  Shall have Experience with Traumatic Brain Injuries (TBI) preferred.

 

HOURS OF PERFORMANCE

 Duty hours are 8 hours per day, 0730 to 1630 hours, Monday through Friday, excluding federal  holidays, with 1 hour unpaid lunch.  Generally, the contract nurse shall not be required to provide services in excess of 8 hours per day, 40 hours per week. 

 Scheduled absences shall be scheduled at least 30 calendar days in advance and mutually agreed upon by the COR or Directorate Chief (or designated representative), and the contractor.

 Unscheduled absences shall be called into the COR or Directorate Chief (or designated representative) by the contract nurse within the first 2 hours of each duty day that he/she is unable to report to work.

 Closures.  In the event the contract employee is required to work during anticipated closure of the facility due to Command declared training holidays, staff administrative leave, or other closure, the contractor shall be paid for actual hours worked.  In the event of unplanned closure of the facility due to natural disasters, military emergency, or severe weather, the contractor shall not be paid.

 Organizational Activities: If determined appropriate by the Directorate or COR, the contract nurse may be invited to participate in organizational events (i.e. organization days, grand openings, holiday parties) as their place of duty in an unpaid status.

 

SPECIFIC TASKS

 

· The contract case manager shall provide patient-centered, individual and family level case management services for all eligible beneficiaries of the Military Health System.  The contract case manager will work collaboratively with the MTF case manager and discharge planner and all other MTF and contract staff such as medical management nurses, population health, beneficiary services, etc.  The contract nurse shall perform essentially the same duties as those required of any military or government civil service nurse of similar experience and in similar duty assignments.  Specific tasks include, but are not limited to, the following:

 

· Provide patient-centered case management and discharge/disposition planning in inpatient and ambulatory care settings for beneficiaries as needed, with early identification and interventions focused on outcomes as defined herein. Accept referrals for case management from all sources and perform initial assessment of each patient referred.

 

· Advocacy to identify care options that are acceptable to the patient and family that lead to increased adherence to treatment plans, and improved healthcare outcomes.

 

· Monitor care delivery to the patient across the care continuum (for example sub-acute, long-term, home health, and hospice care) and document assessments of patient progress in reaching healthcare outcome goals.

· Collaborate with direct and purchased care systems to ensure a smooth transition for patients from one level of care or care setting to another, such as rehab, residential or other care institution.

-  For example, in the case of an Active Duty Service Member (ADSM) with severe head trauma, the contract RN shall collaborate with the Veterans Administration (VA), and Military Medical Support Office (MMSO) to identify best options for the ADSM’s access to transportation, rehabilitative care, or other extended long-term healthcare programs, and coordinate with the Global Patient Movement Requirements Center (GPMRC) for aero medical evacuation, as needed.

· Ensure coordination of care delivery processes to enhance patient’s health and wellness, safety, productivity, and quality of life, to include alternate care settings and the home environment.

· Coordinate discharge/disposition plans to meet the patient’s post-hospitalization and post-acute care requirements, to include:

-  Level of care

-  Follow-up, and services determined by the physician

-  Types of medical equipment needed for in home and post-hospitalization use

-  Rehabilitation/ extended care placement

-  Other care arrangements, as necessary

 The contract Case Manager shall complete a thorough community assessment of MTF and catchment area, local government, and community healthcare systems to identify agencies in place for adult, child, family, senior and group support services, specialty healthcare services, vendors, and all other available community healthcare resources.

 The contract Case Manager shall appropriately manage all patients selected for case management across the care continuum, following the CMSA Case Management Standards of Practice, all MTF policies and procedures, and legal and ethical processes, to ensure the patient’s clinical, bio-psychosocial, safety, financial, cultural, and environmental healthcare needs are appropriately fulfilled in the most timely manner and clinically appropriate setting. 

 To meet military unique mission requirements, contract case manager shall expect surges in patient caseloads to occur during or following contingency operations.  The increased caseload will be for short durations to provide care coordination in the way of discharge/disposition planning and possibly case management for active duty service members and, or to meet family needs of service members. Examples of unique military case management needs include, but are not limited to:

 Cases complicated by psychosocial/environmental factors (for example military personnel who reside in a barracks).

 Cases impacted by family/military circumstances (for example patient whose spouse is deployed, other kids at home, and no other family support).

 Cases which require extensive monitoring and coordination (for example foreign military injured, those soldiers injured with no family, and requires assistance with DME and transportation to and from appointments, PT daily, coumadine clinic, or an elderly person who lives alone).Contract personnel shall use available standardized forms, paper-based or electronic, for documentation of provision of services.  Site specific logs and files shall be required to keep detailed documentation.  Coding of ambulatory case management encounters is required at military MTFs as a method of collecting specific population healthcare data.  The contract Case Manager shall use approved codes for all case management encounters.The Case Manager shall provide case management data and reports as requested.