RN-RN Case Manager Job Description
RN-RN Case Manager Duties & Responsibilities
To write an effective RN-RN case manager job description, begin by listing detailed duties, responsibilities and expectations. We have included RN-RN case manager job description templates that you can modify and use.
Sample responsibilities for this position include:
RN-RN Case Manager Qualifications
Qualifications for a job description may include education, certification, and experience.
Licensing or Certifications for RN-RN Case Manager
List any licenses or certifications required by the position: CPR, BLS, PRI, CCM, AHA, CM
Education for RN-RN Case Manager
Typically a job would require a certain level of education.
Employers hiring for the RN-RN case manager job most commonly would prefer for their future employee to have a relevant degree such as Bachelor's and Associate Degree in Nursing, Education, Graduate, School of Nursing, Management, Health, Science, Associates, Healthcare, Interdisciplinary
Skills for RN-RN Case Manager
Desired skills for RN-RN case manager include:
Desired experience for RN-RN case manager includes:
RN-RN Case Manager Examples
RN-RN Case Manager Job Description
- Monitor continuity of medical services
- Review Plans of Care and ensure they adequately provide services
- Assist in coordinating MLTC care and services under the direction of the organization clinical leadership
- Ensure appropriate documentation is input into the system
- Review assessments of enrollees' physical and mental conditions to inform primary care managers
- Obtain reliable and timely information about physical, behavioral, and primary health care services to ensure safe and effective transitions across settings
- Conduct outreach calls to ensure minimum monthly contact and no service disruptions
- Review Gaps in Care directives, perform outreach
- Document efforts to close gaps
- Assume responsibility for coordinating patient care within the continuum of care among the interdisciplinary team
- Provide ongoing assessment in case management of patients
- Assure compliance with utilization requirements relative to all customer types and contract requirements
- Maintain ongoing communication regarding patient care with physicians, referral sources, caregivers, patients, families
- Independently initiate assessments of situations
- Act as an advocate for an individual’s healthcare needs
- Actively participate in the revenue process which includes the appeal/denial process
RN-RN Case Manager Job Description
- Ensure and assist in developing, implementing, and monitoring the Person Centered Service Plan (PCSP)
- Serve as the lead of the IDT
- Collaborate with members of IDT to assist each Participant in accessing services as identified in the Participant’s Person-Centered Service Plan
- Conduct advocacy, communication, and resource management to promote quality, cost effective, positive outcomes
- Provide referral and coordination of other services in support of the Patient-Centered Service Plan
- Assist Participants to obtain needed medical, behavioral health, prescription and non-prescription drugs
- Patient medical needs
- Patients' ability to perform ADLs
- Benefit interpretation, assisted by Member Services
- Living arrangements pre- and post-hospitalization
- Significant others available to assist
- Patient/family psycho-social status
- 2-4 years of previous Case Management experience in Managed Care
- 2+ years of Acute Care Inpatient experience
- 3+ year of Utilization Review / Management and Case Management experience
- Identify appropriate providers and facilities through the continuum of care
RN-RN Case Manager Job Description
- Provide a patient-centered, interdisciplinary approach to health care and care coordination using comprehensive, evidenced-based care plans developed in concert with the patient/care giver and with the support of the provider
- Cultivates a strong, cohesive, team-oriented relationship with practice partners, including on-site and remote interaction where appropriate, whereby the practices care team considers the case manager as an extension of and integral part of the practices care delivery program
- Screens patients and conducts individualized clinical assessments of patients health concerns/needs
- Evaluates the patients progress in setting and meeting established goals and revises their individualized care plan accordingly
- As appropriate, performs transitions in care assessments for patients discharged from an in-patient hospital or skilled nursing facility
- Advocates, guides and intervenes on behalf of patients, their family and/or care givers, in concert with the PCP, in understanding and navigating the health care system, including the coordination of community resources
- Defines, evaluates and reports on desired and actual patient health outcomes in collaboration with the interdisciplinary care team
- In urgent and non-emergency situations, facilitates the escalation of high-priority, problem patient cases that require direct and/or immediate intervention by the physician care team
- Communicates, collaborates, and coordinates with team members, patients, and families to provide quality patient care and to ensure positive patient outcomes
- Ensures continuity of care through communication in rounds and written documentation
- Proficiency in review criteria to support medical necessity and effective discharge planning
- Proficient with InterQual and MCG (formally Milliman)
- Previous experience with CHHA, Medicaid/Medicare, and Oasis
- 2+ years of hospital case management experience from an acute care facility with more than 200 beds
- Utilize applicable sources of information, identify and enroll patients requiring case management
- Assist the Patient Care Coordinator with the coordination of care for beneficiaries not under case management as needed
RN-RN Case Manager Job Description
- Perform attendant care supervisory visits in accordance with state, program and company policies
- Collaborate on cases for appeals / fair hearing
- Meet threshold amount for minimum required assessments per week
- Maintain all corporate compliance requirements and mandatory training completion
- Manages the member's Individualized Care Plans (ICP) and coordinates the Interdisciplinary Care Team (ICT) meetings, agendas and activities
- Performs home visits and hand on assessments when required
- Coordinates and collaborates member's needs with providers, community agencies, and medical management teams
- Participates in training and professional development and willingly performs all other duties assigned by the Medical Management manager
- Identifies the appropriate utilization of resources across the continuum of care
- Maintains patient/caregiver care plan compliance reporting
- Experience in a Labor & Delivery and OB/GYN setting
- Knowledge of Medicaid and Managed Care
- Three years of recent nursing experience in case management within acute care hospital setting preferred
- 3-5 years experience as a Registered Nurse in an acute care settingCase Management experience is preferred
- Experience working with the OMRDD population
- Previous inpatient Case Management experience
RN-RN Case Manager Job Description
- Implement care plan by facilitating authorizations/referrals as appropriate within benefits structure or through extra-contractual arrangements
- Coordinate internal and external resources to meet identified needs
- Negotiate rates of reimbursement, as applicable
- Assist in problem solving with providers, claims or service issues
- Communicate daily one on one with physicians to determine patient needs (either in person or via telephone)
- Review the patient’s medical record to determine the appropriateness of stay relative to the established inpatient criteria
- Identify patients who do not meet the inpatient criteria and addresses these issues with the physician (s) and healthcare team so that patients are provided care in the most appropriate setting
- Assist in the development of timely discharge plan to the next level of care with other healthcare team members so that continuity of care can be maintained along with the necessary orders and insurance approval obtained for these services prior to discharge
- Collaborate with the patient, family, physician, and healthcare team members to assess the individual patient’s healthcare needs and determine an individualized discharge plan
- Assist in coordinating the patient’s care by effectively collaborating with the physician(s) and healthcare team to provide high quality care and optimize the appropriate use of healthcare resources
- Travel up to 10% (subject to change) for on-site member/provider/employer meetings, events or manager requests with occasional overnight stays
- A Minimum of three years medical/surgical/critical care RN experience is required
- Experience working with the Medicaid Home and Community Based Waiver Program is preferred
- Must have a desire to work with the senior and/or disabled population
- Must be comfortable working on computer
- A minimum of three years current experience in acute care, two of which are in medical-surgical services preferred - other clinical experience in acute care will be considered