Role expectations for the Case Manager includes assessing, planning organizing, implementing and evaluating the care delivery system, across the continuum, to enhance quality patient care while simultaneously promoting cost effective resource utilization. This role integrates the functions of utilization management, discharge planning, continuity of care, infection control surveillance and case management. The Case Manager focuses on the needs of patients/clients and their significant others, while maintaining a balance between outcome, cost, and process. Case Managers analyze and trend data results in order to incorporate efforts and information results with existing systems to optimize efficiency of operational systems through strategic quality leadership. Case Managers combine the roles of clinician, collaborator, consultant and educator to accomplish desired clinical outcomes.
Registered nurse with a compact state licensure or active licensure in Michigan, Washington, Kentucky, or Indiana.
This is a remote position conducting telephonic case management services.
Knowledge of prospective payment systems, managed care, infection control surveillance, patient care, disease processes, discharge planning and continuum of services offered with QCP and externally.
Knowledge of URAC Standards, nationally recognized case management standards, other regulatory bodies and of QCP activities and services related to the performance of duties.
Ability to perform data analysis and to utilize computer systems to record and communicate information to other services.
Excellent verbal and organizational skills to facilitate the case management process and ensure patients and customers are served promptly and with respect. This includes, but is not limited to identifying self by name, role and responsibility regarding the case management program for identification purposes during verbal interactions with patients, families, caregivers and providers.
Clear documentation of medical necessity for all services.
Complete follow through for disposition of cases for Medical Director review, potential quality chart reviews and community resources.
Access patient needs through evaluation of social, cultural and medical history.
Develop an individualized and collaborative case management plan of care with the patient, provider(s) and/or family/caregivers.
Continually evaluate the plan of care based on changing needs.
Must immediately notify the organization of any changes in licensure or board certification status.
Provide input on the performance of support staff.
Other duties as assigned.
Current unrestricted licensure or certification to practice a health or human services discipline in a state or Territory of the United States.
Two years full time equivalent providing direct clinical care to the consumer.
Bachelors of Science in Nursing or certification in specialty area preferred.
TRAITS AND APTITUDES
High level of awareness of pertinent details; excellent organizational skills.
Excellent verbal and written communication skills.
Must handle pressure effectively.
Professional appearance and demeanor.
Able to maintain confidentiality.
Excellent computer literacy and skills with the ability to master programs needed for position.
PHYSICAL DEMANDS AND WORK CONDITIONS:
The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
Must have excellent written and verbal communication skills as well as the ability to observe, assess, guide and evaluate others.
Must be able to hear, speak, and see and to coordinate motor skills.
Must be able to climb, lift 25 pounds, stoop and bend and reach above head.
Ability to collect data, interpret findings, set priorities and carry out established plan.
Ability to read, write and utilize manual and computerized systems of documentation.
Must read a significant amount of information in a relatively short period of time.
About Medical Management
Quality Care Partners (QCP) is a locally developed, not-for-profit physician-hospital organization (PHO) incorporated in 1995. We are strongly committed to improving and maintaining the health of the people we serve by providing excellence in medical management and the premier provider network in Ohio.
Through partnerships with area businesses and carriers, QCP has successfully assisted employers in decreasing their overall healthcare and pharmacy costs.
Our mission is to be the premier comprehensive, cost-effective network coordinating quality healthcare services for all communities served.
To achieve our mission, QCP is committed to:
? Pursuing excellence in delivering and managing cost-effective healthcare based on each patient’s needs.
? Focusing on prevention, appropriate care, and improving the health of the communities served.
? Providing a coordinated and comprehensive continuum of care to meet the needs of patients, payers, and the communities served.