Case Manager- NLC

Reliance Rx Specialty Pharmacy Management; United States; On-site; USD 75,000 - 105,000; Full time

Job summary

Reliance Rx Specialty Pharmacy Management in the United States seeks a qualified Case Manager (RN) to apply the six essential activities of case management within a quality improvement framework. The role emphasizes assessment, planning, implementation, coordination, monitoring and evaluation to support patient outcomes.

Requirements include an active RN license in an NLC state, CCM certification within 3 years, and at least 3 years of med/surg or ambulatory RN experience.

Qualifications

• Active RN license in a Nurse Licensure Compact state is required.
• Case Management Certification (CCM) required or to be obtained within 3 years of starting.
• Minimum 3 years RN experience in med/surg or ambulatory care settings.
• Experience with managed care is a plus; strong collaboration with care teams is essential.
• Ability to assess barriers and coordinate care across physicians and providers.

Responsibilities

• Assess patient needs across medical and social histories to inform care planning.
• Develop and adjust care plans considering physical/psychosocial needs and cost factors.
• Monitor care outcomes and coordinate with interdisciplinary teams for quality improvement.
• Ensure regulatory and privacy standards are met; manage documentation and billing processes.
• Build professional relationships with the care team and communicate care objectives.
• Advocate for patients and identify potential complications in care plans.
• Comply with federal disability laws and knowledge of assistive resources.
• Identify alternative levels of care and coordinate with payors and providers.

Skills

RN license (NLC)

CCM certification

Clinical RN experience

Collaboration with physicians

Communication skills

Problem solving

Education

Bachelor's degree preferred

Job description

FIND YOUR FUTURE

We'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 Arizona, North Carolina & Florida.

Overview

The 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).

Qualifications

• Registered 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 Accountabilities

• Assess 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 staf