Coordinates the utilization of healthcare resources, including transition planning, facilitate the achievement of clinical, quality, financial and member satisfaction goals. This position will transition into a primarily field-based position providing coordination to high-risk, medically complex patients.
PRINCIPAL DUTIES AND RESPONSIBILITIES:
Perform ongoing community and telephonic case management activities of assessment, problem identification, planning, implementation, coordination, monitoring, and evaluation of case managed members
Collaborates with members, caregivers and members of the multi-disciplinary care team to develop a member centered plan of care to meet identified member care goals and outcomes
Develop, implement, evaluate and revise case management care plans according to case management eligibility criteria, contractual guidelines and members physical and psychological needs throughout the continuum of care
Identifies system issues that serve as barriers to care. Participates in development and implementation of strategies to remove barriers and promote resolution through coordination of a problem-solving process
Promote member wellness and autonomy through advocacy, communication, education, and identification and referral to community resources or other case management programs such as disease management programs
Identify appropriate providers and facilities through the continuum of services, and ensure that available resources are being used in a timely and cost-effective manner
Collaborate with embedded and inpatient case managers in the discharge and transitional care process, obtaining and/or coordinating appropriate resources for members throughout the continuum of care
Stratifies and/or validates member level of risk during each transition process and interaction with the member
Collaborates with health care providers in settings not limited to the PCP office, hospital, skilled nursing facility or home care agencies to assist members in coordinating safe
transitions and enhanced communication of the treatment plan to all members of the multidisciplinary care team
Makes referrals to the pharmacist, social worker, respiratory therapist or community outreach team as needed to provide holistic approach to care ensuring safe transitions of care and education
Manages assigned case load in an efficient and effective manner utilizing time management skills to facilitate the total work process directly monitoring assigned members
Demonstrates knowledge of utilization management and care coordination processes and current standards of care as a foundation for transition planning, complex case management and disease management activities
Confers with Medical Directors regarding complex cases requiring physician input regarding the treatment plan or physician to treating physician collaboration
Adheres to organizational and departmental policies and procedures and credentialed compliance
Performs assigned work safely, adhering to established departmental safety rules and practices. Reports to supervisor, in a timely manner, any unsafe activities, conditions, hazards, or safety violations that may cause injury to oneself, other employees, members and visitors.
Performs all other related duties as assigned by Manager/Director
EDUCATION AND EXPERIENCE REQUIREMENTS:
Registered Nurse with BSN required or relevant experience in Utilization Management or Case Management
Active DE RN Licensure, in good standing.
Case Management Certification preferred through the Commission for Case Management (CCM) or within 18 months of hire after completion of 6 weeks of orientation
KNOWLEDGE, SKILL, AND ABILITY REQUIREMENTS:
Strong interpersonal skills relative to both professional and team interactions
Strong organization skills
Demonstrated critical thinking skills and the ability to prioritize workload
Ability to exercise clinical judgment and autonomous decision making
Internal Number: JR50569
About Christiana Care Health System
Christiana Care Health System is headquartered in Wilmington, Delaware and is one of the country's largest health care providers, ranking 21st in the nation for hospital admissions. Christiana Care is proudly a Nurse Magnet recognized institution. Christiana Care Health System is also one of the largest health care providers in the mid-Atlantic region, serving all of Delaware and portions of seven counties bordering the state in Pennsylvania, Maryland and New Jersey. A not-for-profit, non-sectarian health system, Christiana Care includes two hospitals with more than 1,100 patient beds, and is a major teaching hospital with two campuses. Christiana Care is continually recognized for excellence on a regional and national level. Our role in the community is expressed in the Christiana Care Way: "We serve our neighbors as respectful, expert, caring partners in their health. We do this by creating innovative, effective, affordable systems of care that our neighbors value."Christiana Care is a great place to work because we value diversity and recognize it to be a core part of our success. Because of the diversity of our employees, affiliated health professionals and volunteers, we are... positioned to meet the unique needs of our patients and community. We acknowledge and celebrate the uniqueness and talent of each employee. Because of our talented workforce we are able to provide a quality healthcare experience to our patients and community. We strive to create an inclusive environment in which individual diversity can be leveraged and thrive. Christiana Care Health System is an equal opportunity employer, firmly committed to prohibiting discrimination, whose staff is reflective of its community and considers qualified applicants for open positions without regard to race, color, sex, religion, national origin, sexual orientation, genetic information, gender identity or expression, age, veteran status, disability, pregnancy, citizenship status, or any other characteristic protected under applicable federal, state, or local law.