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Title: Case Manager RN
Relocation: Yes
Location: Salem, NH
Through early intervention, the Case Manager will apply the six essential activities of Case Management to assure achievement of an individual’s maximum level of wellness. Via appropriate, quality, cost-effective alternative care delivery, the Case Manager will explore community resources and alternative funding in order to maximize health care benefit. The Case Manager will assist an individual to self-direct and self-advocate thus assurance of an informed and empowered healthcare consumer.
Essential Duties and Responsibilities
- Acts as an advocate and approaches clientele, according to his/her level of wellness, handicap, or injury with alternatives which may improve his/her quality of life.
- Ethically engages in the six essential activities of the Case Management process in order to assess, plan, implement, coordinate, monitor and evaluate health care delivery.
- Applies six components of case management to each of the five core areas: coordination/service delivery, physical/psychological factors, benefit systems and cost analysis, case management concepts and community resources.
- Practices case management within the full continuum of care encompassing multiple environments.
- Interacts with all healthcare systems and continues involvement with all participants to deal with an individual’s broad spectrum of need.
- Applies CMSA standards of practice to an individual’s holistic, healthcare, occupational, psychosocial, cultural and financial need.
- Composes confidential, timely, report mechanisms that clearly document goals, objectives, outcomes and cost benefit analysis.
- Acts as a resource to Utilization Review, Behavioral Health, Disability and Case Management team members, committees, clientele and personnel.
Education and/or Experience
- RN Degree or Diploma.
- Current NH/PA license, RN licensure within state of case management practice.
- 3 years medical, surgical clinical experience: 3-5 years case management or disease management experience.
- Case Management certification.
Knowledge and Skills
- Excellent written/oral/communication skills.
- Intermediate Word, Excel computer skills.
- Demonstrated success as a case manager with basic Utilization Review skills, Managed Care Software knowledge.
- Knowledge of the insurance industry, benefits coverage and claims processing.
- Ability to apply the six components to the five core areas of the case management process.
- Knowledge of case management principals, clinical guidelines, and CMSA standards.
- Ability to prioritize caseload, combining comprehensive nursing knowledge and skill with cost savings methodology and technique.
- Knowledge of health care providers, alternative funding and community resources; ability to prioritize and utilize them efficiently within the benefit plan.
- In depth knowledge of nursing care plans/skill and ability to facilitate and coordinate transition of patients with catastrophic injuries/illnesses through cost effective, medically appropriate, alternative levels of care.
- Actively serves on an committee.
- Participates in in-service/provider education.
- Maintains membership and activity in a professional affiliation, i.e. Case Management Society of America, Case Management Society of New England, ANA in order to promote professional development within the industry.
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