RN Case Management

Detroit, MI

Post Date: 09/01/2017 Job ID: 23436 Category: Registered Nurse

  • M-F 8 hour shift
  • Some weekends may be required.

Job Description:
  • Utilizing a collaborative process, the case manager will assess, plan, implement, coordinate, monitor, evaluate and advocate the options and services required to meet an individual s health needs, using communication and available resources to promote quality, cost effective outcomes.
  • The case manager helps identify appropriate providers and facilities throughout the continuum of services while ensuring that available resources are being used in a timely and cost effective manner in order to obtain optimum value for both the client and the reimbursement source.

  • The case manager will collect in-depth information about a person s situation and functioning to identify individual needs in order to develop a comprehensive case management plan that will address those needs.
  • The case manager will determine specific objectives, goals and actions as identified through the assessment process.
  • The treatment plan is developed in collaboration with the member/authorized representative, treating physician, medical consultant, and, if appropriate, the social worker and keeping all parties informed of the treatment plan progress.
  • The treatment plan should be action oriented and time specific.
  • The case manager will execute specific intervention that will lead to accomplishing the goals established in the case management plan.
  • The case manager will organize, integrate and modify the resources necessary to accomplish the goals established in the case management plan.
  • Identify and coordinate services so that the member s health care needs are met across the continuum of care using the most effective means available.
  • The case manager will gather sufficient information from all relevant sources in order to determine the effectiveness of the case management plan.
  • The case manager will act as the liaison between the member/authorized representative and the facility, provider, and/or the management team through regular contact and collaboration with the member and provider(s).
  • Contacting the member/authorized representative on a regular basis.
  • At appropriate and repeated intervals, the case manager will determine the plan s effectiveness in reaching desired outcomes and goals.
  • This process might lead to a modification or change in the case management plan in its entirety or in any of its component parts.
  • The case manager will advocate on behalf of the member/authorized representative.
  • Conducting a thorough and objective evaluation of the patient s current status including physical, psychological, environmental, financial, and health status expectation.
  • As a patient advocate, seek authorization for case management from the recipient of services (or designer).
  • Assessing resource utilization and cost management; the diagnosis, past and present treatment; prognosis, goals (short and long term).
  • Identifying opportunities for intervention.
  • Assisting members in meeting and managing both health care and quality needs.
  • Setting goals and time frames for goals appropriate to the individual.
  • Identifying quality of care and savings opportunities, negotiating with providers when needed, facilitating the use of appropriate extra-and-contractual benefits, and providing the member with information or links to community, state, and/or federal resources.
  • Maintaining communications and collaborating with patient, family, physicians and health team members and payer representatives.
  • Comparing the patient s disease course to established pathways to determine variances and then intervene as indicated.
  • Introducing, assessing, opening, managing, closing assigned cases with guidance from the POD leader and physician consultant.
  • Routinely assessing patient s status and progress; if progress is static or regressive, determines reason and proactively encourages appropriate adjustments in the care plan, providers and/or services to promote better outcomes.
  • The case manager will document patient profile updates, discuss cases with POD leaders, and schedule case reviews with the physician consultants on a routine basis.
  • Establishing measurable goals which promotes evaluation of the cost and quality outcomes of the care provider.
  • Reporting quantifiable impact, quality of care and/or quality of life improvements as measured against the case management goals.

  • 2 years required.

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