Case Manager - High Risk OB, Neonatal, Cardiology, Neurology, and Pediatric Specialties
A Case Manager is responsible for managing assigned cases and optimizing the clinical and financial outcomes of those cases using clinical experience and following company policies, procedures, and workflows. Occasional visits to client sites may be required.
Responsibilities
Including, but not limited to:
- Utilize clinical and case management expertise to drive the care management process to produce measurable outcomes on assigned cases
- Conduct and document an assessment of each patient, reassessing the patient throughout the case. The initial assessment must be conducted within five business days of case assignment. The patient must be reassessed on a weekly basis until case closure.
- Complete an individual patient-specific plan for each assigned case, including documentation of the following:
- Identification of problems or risk factors that may impede a patient's progress or discharge
- Identification of milestones to be met to achieve a patient's target outcome or discharge
- Identification of case management short and long term goals
- Identification of timeframe for re-evaluation and response to services
- Identification of local resources to support individual case goals and resolve problems
- Identification of collaborative approaches to be used to achieve case goals, including contact intervals and methods
- Communicate with patients or families per case requirements to ensure consent to participate in care management and that risk-specific education is delivered according to company procedures
- Document case management discharge/termination reason and the date of termination
- Document all communications according to company standards
- Create and quality review case reports at assigned intervals
- Review and problem-solve cases with company consultants and director; assist other care managers in problem-solving cases
- Provide coverage for other case managers as required
- Manage assigned cases to termination using company systems, policies, procedures, and workflows
- Ensure the completeness and accuracy in the collection and reporting of all patient clinical and financial data required by company systems
- Communicate with company consultants, treating team, other care providers, client, and the patient or family to gather and synthesize all pertinent case information
Qualifications
Education and Certifications
- Bachelors or higher degree in a health related field and licensure as a health professional (where such licensure is available); or
- Active, unrestricted nursing license in the state in which you reside and
- Completion of state-mandated education programs, as required by state license
- CCM or ACM Certification helpful
- Project Management Professional (PMP) Certification helpful
Experience
- Three (3) years of clinical practice experience in High Risk OB, Neonatal/NICU, Cardiology, Neurology, and Pediatric specialties
Skills
- Strong problem-solving and organizational skills
- Ability to work independently and as part of a collaborative team
- High degree of motivation and creativity
- Strong written and verbal communication skills
- Excellent computer skills, specifically Microsoft Excel
- Team Player
