RN- CASE MANAGER

Summary

The RN Case Manager will provide clinical case management services to all residents to include but not limited to development and management of care plans, clinical representation at care conferences, maintain regulatory compliance for care planning, DDA partnership support, and clinical advocacy for pediatric and young adult residents with complex medical needs. The RN/clinical case manager will serve as a liaison between clinical care team/social work team/rehab team, families, providers, supplies, insurance and outside entities to ensure all resident care needs are met. The RN case manager is responsible for driving resident clinical growth and development through setting and achieving clinical goals that demonstrate multidisciplinary collaboration and a patient centered approach. The case manager is supported by a multidisciplinary team for corresponding resident care plan input and goal development. Contributes to organizational operations through the principles of high reliability to support the mission and a culture of safety.

Job Responsibilities/Essential Functions

Clinical

• Works with the Director of Nursing Services (DNS) and Director of Social Work (DSW) to ensure resident plans of care are in place and executed
• Provides administrative and clinical oversight of resident care plan building and document management to ensure care plans meet requirements for all state entities
• Collaborates with DSW, Physical Therapy Rehab Manager, Life Enhancement Specialist, providers and family to build and maintain a multidisciplinary, individualized care plan and SMART goals.
• Completes initial resident clinical assessment and develops individualized care plan, nursing diagnosis, and clinical SMART goals (short and long term) in collaboration with family and providers.
• Prepares documentation for care conferences, and attends virtually to represent nursing, may collaborate with other departments and in person counterparts as needed
• Manage and provide necessary clinical DDA correspondence and records, and attend DDA assessments virtually in partnership with on site clinical and or social work support.
• Provides guardian/parent correspondence for clinical needs-chart maintenance, resident specific advocacy order management, approvals etc.
• Work with insurance companies, providers, pharmacy and DME suppliers to provide support for prior authorizations, denials and needed changes
• Advocate for residents and families to support clinical needs
• Track resident immunizations and work with parents/guardians for consent for annual immunization program
• Oversees resident referrals and admissions

Documentation

• Responds to all inbound referrals for respite and residential care.
• Completes intake process and forwards to DNS and DSW for review and outreach
• Complete intake assessments (resident application) and build care plans
• Enters resident into EMR and builds profile
• Disperses resident information to nursing, SW, PT/Rehab, supplies and transport in a timely fashion to allow each department to prepare for admission
• Prepares and ensures all documentation is in place for admissions and discharges
• Processes and maintains all information in EMR or other specific electronic document management

Leadership

• Adheres to the professional standards of nursing practice and provides care and services consistent with the mission
• Adhere to HIPAA and all state and federal medical privacy laws
• Serves as a role model for high reliability
• Other duties as assigned

Skills and Abilities

• Must demonstrate the ability to practice competently in the delivery of nursing care.
• Must demonstrate good organization, leadership, and teamwork skills
• Knowledge of state and federal healthcare regulations pertaining to home health care and adult family homes.
• Knowledge of organizational policies, regulations and procedures necessary to administer safe and effective resident care.
• Ability to react calmly and effectively in emergent or stressful situations.
• Ability to read and write English proficiently, comprehend and follow oral and written instructions, to communicate effectively with residents, resident’s families, other personnel, and other health care agencies.
• Emotional Stability; calm demeanor and patience. Ability to manage emotions during emergencies and other stressful situations. Ability to maintain caring nature while administering residents' care.
• Adhere to organization’s policies and procedures.
• Ability to demonstrate sensitivity and respect to community members from multiple cultures, and to individuals who experience disabilities.
• Ability to develop and maintain multidisciplinary care plans that align with regular on licensing needs across all homes.

• Bachelor's degree in nursing with a current RN license
• CCM certification
• At least two years of clinical experience, with pediatrics and complex medical care
• At least one year of case management with special need population
• Must pass a State and Federal Background Check, including fingerprints
• Valid State Driver’s License
• Must maintain current vehicle insurance
• Current Healthcare Provider BLS/CPR
• Current Food Handler’s Permit or within 30 days of hire
• Proof of licensing required vaccinations
• Abuse Prevention Systems Sexual Abuse Awareness Training within 90 days of hire
• DDA Developmental Disabilities Specialty Training within 90 days of hire
• DOH In Home Services Orientation Class within 90 days of hire
• Must acquire and provide proof of 30 hours of CEU’s per year