Overview

Provide in-patient Care Management services to a contracted community based high-risk population. Contracted population includes members of the following: Medicare Advantage Plans, Physician Provider Networks, and Employer Plans. Goal is to promote quality cost-effective outcomes. Case Manager will interact with all levels of personnel, medical staff, patients, community resources, providers and families to perform case assessment and collaboration for THN Care Management eligible inpatients. Relay pertinent clinical and psychosocial patient information on existing THN Care Management patients to the healthcare team. Case finding and discharge planning liaison for THN Care Management eligible inpatients. Serves as a liaison between THN Care Management, the healthcare team, and the THN Care Management patient population to ensure a quality care transition. Follows-up appropriately and consistently to ensure discharge arrangements are understood for high-risk THN Care Management members to ensure quality care transition. Case Manager will advocate for appropriate resources available in the community, and across the continuum of care to best meet needs of the client. Provides on-going education about the THN Care Management program to physicians and healthcare providers and the THN Care Management patient population

Talent Pool: Nursing

Responsibilities

Case finding and discharge planning liaison for THN Care Management eligible inpatients. Identifies THN Care Management patients having discharge planning needs and collaborates with the acute care team and THN Care Management care team in the development of a discharge plan Initiates family meetings/conferences as needed to facilitate the coordination of services. Participates in inpatient progression team meetings on THN Care Management contracted clients. Collaborates with THN Care Management Care Team as needed. Facilitates prompt discharge. Proactively identifies patients appropriate for THN Care Management services. Initiates THN Care Management's intake process and enters start of care data into the THN Care Management electronic documentation system the transfer of patients to alternate levels of care coordinating with the HMO, the facility, the physicians and the patient's family. Monitors patient progress until discharged back into the community. Independently assigns patients to THN Care Management case managers keeping caseloads balanced and geographically consolidated--------------------------------------------------Follows-up on THN Care Management inpatients discharged from the hospital with complex medical and psychosocial issues to evaluate and ensure continuity of care. Consistently follows up with patients following hospital discharge to assess progress, identify needs and implement appropriate and cost effective plans to address needs. Works closely with payors to establish coverage, avoid denials and facilitates authorizations for additional services as needed. Prioritizes workload to balance patient and administrative needs. Performs other duties and responsibilities as assigned.--------------------------------------------------Performs case assessment for THN Care Management eligible inpatients to ensure effective utilization of acute services. Conducts screenings and assessments on the THN Care Management inpatient population to gain a thorough understanding of the clinical and psychosocial picture. Collaborates with the Care Team in the development of a discharge plan to ensure a quality care transition. Collaborates with the Acute Care Management staff as indicated if payor utilization data is lacking for authorization in a timely and accurate manner. Problem solves coverage issues as needed. Coordinates with the payor to facilitate any required authorizations. Negotiates benefits as needed, to provide for the individual patient's needs. Serves as a patient advocate to obtain necessary services not covered by the payor as appropriate. Provides expertise on plan benefits and available patient resources. Demonstrates cost savings. Follows the CMSA National Case Management Standards of Care.--------------------------------------------------Provides THN Care Management services to high-risk members. Communicates effectively with the healthcare team members to ensure patient needs are addressed promptly. Willingly acts as a patient advocate and communication link with care providers and community resources. Effectively educates patients regarding health care benefits, insurance and managed care issues. Follows-up appropriately and consistently to ensure discharge arrangements are understood for high-risk THN Care Management members to ensure quality care transition.--------------------------------------------------Serves as a liaison between THN Care Management, the healthcare team and the THN Care Management patient population. Serves as a communication link with other healthcare providers and community resources Provides ongoing education about the THN Care Management program to physicians and healthcare providers and the THN Care Management patient population. Collaborates with peers to discuss patient's needs and caseloads as new patients are assigned.--------------------------------------------------

Qualifications

EDUCATION:Bachelors, Nursing, Required

EXPERIENCE:

LICENSURE/CERTIFICATION/REGISTRY/LISTING:REQUIREDValid North Carolina Registered Nurse license to practice in the state of North Carolina.PREFERREDNational certification in case management field preferred