Case manager- NLC

Independent Health; Buffalo (NY); On-site; USD 101,887,000 - 108,886,000; Full time

Benefits offered by this job

Scorecard incentives

Full benefits package

Generous paid time off

Job summary

Independent Health is seeking a Registered Nurse Case Manager to apply comprehensive case management across social and medical needs in a multistate licensure context. You will develop care plans, coordinate care with physicians and the inter-disciplinary team, and drive outcomes while maintaining regulatory standards.

The role requires CCM certification and at least three years of RN experience in med/surg or ambulatory settings.

Qualifications

• RN with active, current, unrestricted license in an NLC state required.
• CCM certification required; must obtain CCM within 3 years if not held.
• Three years of clinical RN experience in med/surg or ambulatory care.
• Experience in managed care is a plus.
• Clinical knowledge of health or social work needs for the population served.
• Ability to identify barriers to care management; interact with physicians.
• Excellent problem-solving, time management and communication skills.
• Flexibility in work schedules and assignments.
• Familiarity with Nova Core 4 values: Act with Passion, Work Together, Be Accountable, Build Trust.

Responsibilities

• Assess patient needs through evaluation of social and medical history.
• Develop a care plan considering physical and psychosocial needs and cost factors.
• Continuously evaluate the plan and monitor care quality with the inter-disciplinary team.
• Ensure regulatory and privacy compliance and coordinate documentation.
• Build professional relationships and communicate objectives to involved parties.
• Advocate for patients and assess potential complications.
• Apply ADA principles and know assistive equipment.
• Identify community resources to support recovery and assist access.
• Collaborate with payor and providers to evaluate quality and cost-effectiveness.
• Identify cases needing alternative levels of care and implement changes.

Skills

RN license

Problem-solving

Interpersonal skills

Time management

Physician interaction

Education

Bachelor's degree preferred

Case Management Certification (CCM)

Job description

FIND YOUR FUTUREWe're excited about the potential people bring to our organization. You can grow your career here while enjoying first-class perks, benefits and a culture that fosters growth, innovation and collaboration.Accepting RN Candidates that reside in North Carolina and Florida Only.OverviewThe Case Manager will be responsible for applying the six essential activities of case management which include assessment, planning, implementation, coordination, monitoring and evaluation with the core components through the administration of quality improvement functions (process, relationships, health care management, community resources and support, service delivery and psychosocial intervention).QualificationsRegistered Nurse (RN) with active, current, unrestricted license in a Nurse Licensure Compact (NLC) state required. Bachelor’s degree preferred.Case Management Certification (CCM) required. Candidates without CCM certification are required to obtain it within three (3) years of commencing employment.Three (3) years of clinical RN experience in a med/surg or ambulatory care setting required. Clinical experience in at least one of the following areas preferred: Behavior Health, Transplant, Neo-Natal or Oncology.Previous experience in managed care a plus.Clinical knowledge of the health or social work needs for the population served.Ability to identify barriers to a successful care management path.Ability to interact effectively with physicians and other members of the health care team.Excellent problem-solving abilities, coupled with solid time management skills.Excellent written, verbal and interpersonal communication skills.Transferable knowledge, skill and ability to complete job duties independently and proficiently. Flexibility in work schedules and assignments.Proven examples of displaying Nova’s Core 4: Act with Passion, Work Together, Be Accountable, Build Trust.Essential AccountabilitiesAssess the patient’s broad spectrum of immediate and long-term needs through evaluation of the patient’s social and medical history.Develop a plan of care based upon the patient and providers of care clinical assessments, considering physical and psychosocial needs, the benefit plan and cost benefit analysis factors which impact the patient’s optimal recovery.Continuously evaluate the plan of care within the scope of case management practice based on the changing needs of the patient and monitor the quality of care and effectiveness of care being provided for all involved members of the inter disciplinary team.Ensure compliance with regulatory and privacy standards, prompt payment/reimbursement and appeal process as indicated; coordinate the decision and documentation process; maintain a current and accurate database.Establish professional working relationships with all members of the interdisciplinary team and communicate case objectives to the appropriate involved parties.Act as a patient advocate understanding and identifying potential for complications, understanding methods for assessing the current and future physical and psychosocial characteristics of illnesses.Read, understand and apply principals of the American with Disabilities Act and understand federal legislation affecting individuals with disabilities.Be knowledgeable of assistive and adaptive equipment.Establish available support systems and be versed in methods of researching and interviewing community resources to assist the patient in achieving maximum psychological, social and physical recovery.Effectively communicate to the patient the available services and resources applicable to the patient’s immediate and future needs. Assist the patient in obtaining these services.Identify cases that would benefit from alternative care through assessment and evaluation of the patient’s needs, as well as available resources.Work closely with the payor, providers and all involved team members in evaluating the quality and cost effectiveness of services. Negotiate cost discounts when appropriate.Identify cases that would benefit from alternative levels of care and resources (i.e. rehabilitation facilities and home health care providers). Implement alternatives to existing care, considering quality of care and the patient’s current and ongoing needs.Understand case management concepts such as roles, philosophies, principles, liability and confidentiality issues. Apply these concepts in developing appropriate plan of care and goals based on the needs of the patient.Be knowledgeable in applying problem solving techniques to the case management process. Analyze and evaluate outcomes and implement alternatives when appropriate.Document the patient’s plan of care in a timely manner.Maintain professional status within the community through membership in professional organizations and/or participation in continuing education.Participate in Nova’s training and education committees as assigned. Provide input into support staff orientation and training as it relates to the Case Manager’s role.Provide support, guidance, and direction to support staff as indicated.Perform all assignments in a professional manner.Be knowledgeable of the scope of practice of their multi-state licensure and practice accordingly.Immigration or work visa sponsorship will not be provided for this positionHiring Compensation Range: $35.50 - $38.00 hourlyCompensation may vary based on factors including but not limited to skills, education, location and experience.In addition to base compensation, associates may be eligible for a scorecard incentive, full range of benefits and generous paid time off. The base salary range is subject to change and may be modified in the future.As an Equal Opportunity / Affirmative Action Employer, Independent Health and its affiliates will not discriminate in its employment practices due to an applicant’s race, color, creed, religion, sex (including pregnancy, childbirth or related medical conditions), sexual orientation, gender identity or expression, transgender status, age, national origin, marital status, citizenship and immigration status, physical and mental disability, criminal record, genetic information, predisposition or carrier status, status with respect to receiving public assistance, domestic violence victim status, a disabled, special, recently separated, active duty wartime, campaign badge, Armed Forces service medal veteran, or any other characteristics protected under applicable law. Click here for additional EEO/AAP or Reasonable Accommodation information.Current Associates must apply internally via the Job Hub.