Roles & Responsibilities:

The Case Manager functions as a core member of a collaborative care team involving the patient, his or her family, and providers, ensuring that the resources available in benefits are used to maximize health and well-being. Combining a passion for nursing with an understanding of evidenced-based practice, the Case Manager will be responsible for developing a plan of care, matching the needs of the member with appropriate services, and serving as a supportive resource for navigation towards optimum health. The Case Manager strives to promote self-managed care and the use of healthcare and community resources in the most cost-effective way possible. This position reports to the Director and utilizes an understanding of wellness, chronic disease management, utilization management, transitional care, and discharge planning objectives.

Core Functions:

• Applies principles of person-centered, shared decision making and health coaching
• Demonstrates a sensitivity and responsiveness to a variety of cultural values, beliefs, and social determinants of health.
• Seeks to develop trusting relationship with assigned members within a specific population through communication and understanding of the disease process. Completes health risk assessments and medication reconciliation as a baseline for understanding of current problems and member knowledge.
• Analyzes data available to identify appropriate candidates for care coordination based on risk factors, level of care, gaps in compliance. Incorporates member’s goals and disease specific and preventative measures knowledge base or deficits in monitoring health, wellness and chronic conditions into care plan development.
• Develops a plan of care. Implements a plan of care with appropriate resources and community support.
• Monitors the plan of care to determine if the goals are being met on an ongoing basis; revises and updates care plan timely.
• Applies appropriate criteria for each level of care.
• Ensures patient, caregivers and providers receive timely information for treatment decisions across all settings.
• Provides and coordinates transition services across all settings of care.
• Provides clinical oversight of the care plan and care coordination process implemented by Care Coordinators.
• Collaborates with the Provider to update and revise the plan of care from an integrated approach.
• Identifies and reports quality of care issues to the Director.
• Maintains accurate records to document and monitor care activities.
• Promotes the mission, philosophy, goals, and policies of the company through staff education.
• Monitors delegated review activities as outlined in each client agreement.
• Maintain personal professional development and ongoing requirements for licensure.
• Participates in regular case/staffing meetings and reviews.
• Performs other duties as assigned.

Qualification Requirements

• Registered Nurse (RN) with current, valid, unrestricted license in state of Louisiana
• 3 years of various clinical experiences.
• Ability to utilize nursing skills to understand and coordinate care of those members that are significantly physically compromised by their illness and/or disability.
• Accountable and autonomous.
• Ability to handle multiple demands of diverse workload and prioritizes critical issues.
• Verbal and written communication skills
• Analytical skills and sound clinical judgement.
• Ability to build effective collegial relationships.
• Ability to influence and effect changes.
• Knowledge of utilization management, care coordination, and discharge planning concepts.
• Good time management skills.
• Positive service-oriented attitude. High level of integrity.
• Current and valid driver’s license and vehicle.
• PC Proficiency to include Microsoft Word, Excel and database experience.

Preferred Job Requirements:

• CCM highly desirable.
• Telephonic care coordination experience