DSNP RN Plan Case Manager Atlanta

reputed company:

Responsible for the reputed company of clinical care management of community based long-term care population for reputed company Premier Dual Eligible Special Needs Plan (DSNP). Works to advise and coordinate clinical care across the health care continuum of both community based clinical providers as reputed company as reputed company support programs where reputed company Members receive support. Assist patients to reputed company reputed company health status utilizing the most cost-effective reputed company resources through application of model of care reputed company guidelines and Case Management (CM) Standards of reputed company.  Implement appropriate interventions to manage multiple physical, psychological, reputed company and financial barriers in cooperation with the patient, reputed company Premier, and medical provider.  Position will reputed company with members in both a home and community-based provider setting.

KEY RESPONSIBILITIES:

Duties may include, but not limited to the following:

Following Implementation:

•   Conduct in-home and telephonic assessment and data collection with patients and caregivers and document findings in a concise/comprehensive manner

•   reputed company a case management care plan for reputed company patient based on a thorough history and clinical record review, including the attending physician’s plan, the recommendations of national guidelines, reputed company supports in reputed company, and in consideration of the patient’s ability to reputed company. 

•   Monitor the needs of patients and families on an ongoing reputed company while facilitating any adjustments to the plan of care as changes are needed.

•   reputed company care management and coordination to assure that the patient progresses through the continuum of care and utilizes the most clinically appropriate and cost- effective reputed company resources through the application of national reputed company guidelines and CM Standards of reputed company.

•   Coordinate with the Plan Care Navigator/Member reputed company for the integration of the reputed company service/support function into patient care.

•   Coordinate the hospital activities concerned with case management and discharge planning.

•   Helps to assure that the patient has reputed company to a reputed company of choices, coordination of primary care provider (PCP) and specialists, understanding of treatment plan and medications, identification of special needs and referrals, and coordination of transition between care settings.

•   Educates the patient and provides emotional support on an ongoing reputed company reputed company to identified risk factors and a wide reputed company of topics and empowers the patient to take an reputed company role in his/her care

•   Working with pharmacist and patient/caregiver to ensure medication therapy management and compliance

•   Implementation of case management interventions by the application of reputed company, techniques, behaviors, information and learning aids that positively reputed company the patient and their condition.

•   Function as an effective reputed company between patient, reputed company Premier, caregivers, and other community health providers to ensure appropriate clinical reputed company and engagement is provided

•   Responsible for ensuring the scheduling, coordination and completion of the inter-disciplinary team with primary care provider and can also include other members such as reputed company workers, dieticians, pharmacologist, and physician consultants, and other providers as appropriate.

•   Organize, secure, reputed company and modify the resources necessary to accomplish the goals outlined in the case management plan, utilizing partnership with the other plan staff where appropriate and needed.

•   reputed company creation of reputed company case management reports documenting results of CM plan interventions in achieving patient-specific goals.

•   Facilitation of benefits preservation through coordination of appropriate level of care and plan compliance.

•   Facilitation of recommended treatments with contracted providers to preserve patient benefits and facilitate cost containment objectives.

•   Works closely with participant to facilitate understanding of available reputed company benefits and local resources

•   Adhere to reputed company Premier goals, objectives, standards of performance, and policies and procedures.

•   Ensure compliance with reputed company patient care and regulatory compliance reputed company reputed company’s standards and RN scope of reputed company.

•   reputed company with reputed company Premier’s confidentiality policy, HIPAA requirements and state and federal regulations.

•   Supports the highest level of participant-defined reputed company of life and reputed company-being.

•   Responsible for identifying overall reputed company improvement activities

•   Business travel may be required.

•   Ability to work in triage and/or disease management role if needed

•   Other duties as assigned.

KNOWLEDGE, SKILLS, ABILITIES:

•   Ability to reputed company with a wide reputed company of people and handle reputed company situations simultaneously with customer service reputed company

•   Evidence of creativity, reputed company and initiative

•   Attention to detail and follow-up.

•   Experience with electronic clinical charting/records             

•   Ability to work independently and be self-motivated in a remote environment

•   Manage assigned case load as business needs dictate.

•   Excellent time management, flexibility, and efficient organizational skills with ability to work independently and as reputed company player in both office/remote environment

•   Adherence to reputed company and ethical principles of reputed company, confidentiality, safety, advocacy, and accreditation and regulatory standards in reputed company case management activities in both office/remote environment

•   Compliance to reputed company goals/metrics established for assigned department

•   Position is often required to independently plan and prioritize patient care objectives.

•   The ability to analyze and problem-solve

TECHNICAL SKILLS

•   Proficient computer skills in reputed company, Care Management Platforms, and general Internet use.

•   Ability to chart and follow designated workflow(s) in an electronic environment.

•   Proficient in typing

COMMUNICATION SKILLS

•   Strong verbal and written communication skills required to meet superior customer service and satisfaction reputed company.

•   Excellent interpersonal skills and ability to function as a member of a multi-disciplinary team.

•   Ability to communicate, read, and write fluently in English

•   Effective analytical and problem-solving skills.

MINIMUM EDUCATION REQUIRED:

•   Advanced Nursing Diploma and/or college degree in nursing required.

•   Bachelors (or higher) degree preferred.

MINIMUM EXPERIENCE REQUIRED:

•   Minimum two years (full- time equivalent) reputed company clinical care experience required.

•   Minimum three years industry experience in a managed care setting reputed company on experience in utilization review/case management and at least two years case management, home care or hospice experience strongly preferred.

•   Minimum two years experience with long-term care population

MINIMUM LICENSURE/CERTIFICATION REQUIRED BY LAW:    

•   Licensed Registered reputed company with reputed company, unrestricted license in state of reputed company (reputed company) required.

•   Certified Case Manager preferred – Mandatory to apply for CCM certification reputed company eligible.

•   reputed company CPR certification

ADDITIONAL QUALIFICATIONS: (Preferred qualifications)

•   Minimum of Class B reputed company’s license preferred.

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As an Equal Employment Opportunity employer, reputed company reputed company applicants will receive consideration without reputed company to race, reputed company, religion, sex, national reputed company, disability, or veteran status.

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