[Close] 

RN/Case Management Coordinator II (1367)

Company Name:
Mercy Health System - WI
JOB SUMMARY
Case Management activities will be supervised by a Certified Case Manager(CCM) until CCM successfully obtained. Responsible for performing highly detailed complex case management (CM) activities for individual plan members. Able to perform a screening to determine if member has the potential to meet criteria for a full assessment and enrollment into Complex Case Management. Responsible for independently performing a complete assessment for the purpose of developing an Individualized Care Plan that address identified objectives and goals. Able to identify key team members for participation on individual member's Interdisciplinary Care Team. Appropriately uses metric tools to provide measurements on progress. Appropriately identifies evidence-based guidelines that should be followed for each individual complex case management participant.
May also be responsible for coordinating and monitoring quality initiative and reviews including but not limited to, focus studies, clinical guidelines and preventative health guidelines. Attends and contributes as required to Health Plan committees such as Quality Taskforce and others assigned.
ESSENTIAL DUTIES AND RESPONSIBILITIES
Will spend no less than seventy-five percent of time providing direct case management activities on the phone, face to face, e-mail or other interactive methods
Collects and assesses in depth information about a persons situation and functions to identify individual needs in order to develop a comprehensive individualized care management plan that will address those needs, meet goals and improve health outcomes
Determines specific objectives, goals and actions designed to meet the clients needs as identified through the assessment process; determines benefits/coverage of medical necessity based on MercyCare''s medical certificate of coverage
Executes specific case management activities and or interventions that will lead to accomplishing the goals set forth in the case management plan.
Organizes, integrates and modifies the resources necessary to accomplish the goals set forth in the case management plan.
Monitors the ongoing process by gathering sufficient information from all relevant sources about the case management plan and its activities and determine the plans effectiveness.
Evaluates case managements effectiveness in reaching desired outcomes and goal and makes modifications or changes in the case management plan based on the evaluation.
Participates as educator and resource person for provider offices and hospital staff as it pertains to the health plan case management policy and procedures.
Will spend no more than Twenty-five percent of time coordinating and monitoring non direct case management activities and administrative activities.
Demonstrates knowledge of NCQA Complex Case Management requirements and evidence-based guidelines and where to locate the most effective guideline.
Ability to assist with performing of case/barrier analysis, baseline study analysis and create Quality -Improvement studies and sound study design and interventions
Assists in the gathering and analysis of data
Insures that all activities are internal and external customer focused, well planned, organized and controlled to assure the cost effectiveness of all programs.
Assists in the staff support activities of the UM/QI Committees and other special projects or tasks as assigned by the supervisor.
Assists with developing and updating policy and procedures for the Quality Health Management Policy and Procedure Manual.
Meets CMS standards of documentation and NCQA standards of documentation.
Able to obtain written consent from members for program participation.
Facilitates meetings and skillfully interacts professionally but in a persuasive manner with physicians and other health care providers.
Achieves consensus on Individualized Care Plans.
AGE OF PATIENT POPULATION
Pediatric, adolescence, adult, and geriatric
COMPETENCIES
To perform the job successfully, an individual should demonstrate the following competencies :
Quality - Follows policies and procedures.; Adapts to changes in the environment.; Demonstrates accuracy and thoroughness.; Looks for ways to improve and promote quality.; Applies feedback to improve performance..
Service - Responds promptly to requests for service and assistance.; Meets commitments.; Abides by MHS confidentiality and security agreement.; Shows respect and sensitivity for cultural differences..
Partnering - Supports organization''s goal and values.; Exhibits objectivity and openness to other''s views.; Gives and welcomes feedback.; Contributes to building a positive team spirit.; Generates suggestions for improving work..
Cost - Conserves organization resources..
EDUCATION, TRAINING, & EXPERIENCE
Bachelor''s degree preferred from four-year college or university and two years related experience; or Associate Degree or Diploma Degree and four years related experience and/or training; or equivalent combination of education and experience.
CERTIFICATION/LICENSURE
RN licensure for State of WI or IL (and eligible for licensure in the other state)
Certified Case Manager (CCM)
OTHER SKILLS AND ABILITIES
Demonstrates knowledge of case management activities and core components
Provide case management to members who meet specific criteria for complex and specific disease management
Demonstrated ability to work within a team environment
WORK ENVIRONMENT
The noise level in the work environment is usually quiet.
Occupational Exposure is Category C which means no employees in the specified job classifications have occupational exposure
INFORMATION ACCESS
Partner may access patient care information needed to perform their job duties
Partner may access financial data
Partner may access strategic and planning data
WORK CONTACT GROUP
MercyCare Insurance Company, Clinical and Hospital staff, plan members and with permission any associated caregivers
SPECIAL PHYSICAL DEMANDS
While performing the duties of this job, the employee is frequently required to sit. Specific vision abilities required by this job include close vision, peripheral vision and ability to adjust focus.
LEVEL OF SUPV/SUPERVISES
This job has no supervisory responsibilities of other employees. The Complex Case Management Coordinator is responsible for the management and coordination of services that are part of the care plan for the individual members that meet criteria for participation. Also responsible for coordinating and facilitating Interdisciplinary Care Team meetings for individual members and assuring that the team members have the Individualized Care Plan and that it is being implemented for the member.
Computer Skills
To perform this job successfully, an individual will be using the computer for documentation a majority of the time and should be able to type proficiently on a keyboard and have proficient knowledge of Microsoft Office Specifically, Microsoft Outlook, Word, Access and Excel. An individual should be able to view and understand areas in MHS Power and EPIC EMR.
Other Qualifications
The successful CM Coordinator must be able to function at a highly independent and autonomous level. The CM Coordinator insures that all activities are individually focused for the customer to improve health outcome. All activities are well planned, organized and controlled to assure the cost effectiveness of the various programs. The incumbent identifies key case management problems and quality issues, trends and variances and determines what information is necessary to develop solutions. Acts as an external and internal spokesperson for the department and support system wide efforts and resolutions.

Don't Be Fooled

The fraudster will send a check to the victim who has accepted a job. The check can be for multiple reasons such as signing bonus, supplies, etc. The victim will be instructed to deposit the check and use the money for any of these reasons and then instructed to send the remaining funds to the fraudster. The check will bounce and the victim is left responsible.

More Jobs

Travel Dialysis RN - Superior WI
Superior, WI Fresenius Medical Care
SCHEDULING COORDINATOR, FH - DREXEL TSHC - MED...
Oak Creek, WI Froedtert & The Medical College of Wisconsin
Trade Compliance Data Coordinator
Oak Creek, WI Uline
Senior Manager Histology NA Region
Madison, WI Covance
Clinical Services Account Coordinator
Green Bay, WI FSSolutions - Green Bay
Registered Nurse (RN) - Surgical Unit 1 - 32 h...
Green Bay, WI St. Vincent Hospital