Under the general direction of the Manager of Case Management, this nurse case manager identifies, screens, tracks, monitors and coordinates the care of members with multiple co-morbidities and/or psychosocial needs. The position has frequent or daily needs access to confidential information and protected health information. Other duties as assigned.
Essential Duties (at least 5 that are non-negotiable duties and are absolutely pertinent to successfully completing the job without accommodations):
• Complete a comprehensive physical, medical, and psychological assessment on high risk high cost patients via telephonic interview.
• Establish care plan, goals, interventions, and contact schedule based on risk category, and patients/family members identified medical and social needs
• Promote compliance with disease specific clinical outcomes by providing each individual with self-management supports including disease specific education materials, nutritional recommendations, exercise/activity, signs/symptoms to watch for and report to your MD, and Care plan and treatment goals including self-management goals
• Coordinate care and communication between multiple providers, medical, nursing, social, and behavioral health.
• Must be able to independently travel off-site to various locations.
• Clinical knowledge in the treatment of injuries, diseases and deformities including symptoms, treatment alternatives, drug properties and interactions and preventive health guidelines.
• Working knowledge of Case Management principles and processes
• Experience in Medicaid Managed Care including STAR and CHIP.
• Experience with Commercial, Health Care Exchange Programs and other county programs.
• Ability to manage workload efficiently and effectively and within established policies and procedures.
• Excellent interpersonal skills with the ability to interface and interact effectively with members, providers, health plan staff and other external customers.
• Strong verbal, listening and written communication skills including detail oriented and concise documentation skills.
• Knowledge of HHSC, TDI, NCQA and HEDIS regulations, standards, or measures to assure overall compliance with all standards.
• Working knowledge in the use of a personal computer and of Microsoft Office products including Word, Excel, Outlook, and Power Point.
People Management/Department Management/Business Unit Management:
• Develops, implements, monitors, and evaluates the case management health risk assessment and nursing plan of care as outlined in policies and procedures
• Interacts and collaborates with the interdisciplinary care team to review clinical assessment and update nursing care plans
• Serves as an advocate and clinical resource for members and their families by providing constructive information regarding their disease process and available resources to minimize problems and increase customer satisfaction
• Performs non-invasive home and/or in-patient assessments to include medication reconciliation, education, and home safety evaluation
• Coordinates with internal and external social services agencies, contracted providers, and programs to ensure that members receive needed and timely services across the continuum of care
• Attends staff development educational training to support professional growth
• Maintains compliance with all regulatory standards
• Identifies improvement opportunities and maintains quality standards
• Performs other duties as assigned
MINIMUM EDUCATION: Completion of an accredited Registered Nursing Program
PREFERRED EDUCATION: Bachelor’s degree in nursing or health related field
• 3 years of experience in community health setting, public health, chronic disease management, community nursing, case management
• Experience in care coordination and disease management/education
• Experience working with primary care providers in practice setting to coordinate care and disease management
• Strong communication skills, both verbal and written
• Knowledge of case management, disease management, and chronic care principles
1. Active and unrestricted state Registered Nursing License in good standing
1. All Sendero Case Managers will be expected to obtain their Commission for Case Manager Certification (CCMC) OR American Nurses Association Nursing Case Management Certification (ACMA) within 3 years of hire