Hospice RN Case Manager

Gonzaba Medical Group; Cassin (TX); On-site; USD 65,000 - 90,000; Full time

Job summary

Gonzaba Medical Group in San Antonio, TX is seeking an experienced RN Case Manager to provide quality care coordination for high-risk patients. You will direct patients to timely healthcare services by phone, manage care plans, and collaborate with GMG providers to reduce readmissions.

The ideal candidate is a state-licensed RN with a BSN and at least three years of clinic or managed care experience, with superb communication and organizational skills. This role is on-site at 933 Pleasanton Rd.

Qualifications

• Must be a state-licensed RN with a BSN and 3+ years in clinical settings.
• Experience in managed care and care coordination preferred.
• Excellent written and verbal communication; strong attention to detail.

Responsibilities

• Direct patients to appropriate care levels based on history, symptoms, and provider advice.
• Follow approved triage protocol guidelines.
• Maintain high-risk patient census and stratify care needs for home visits.
• Place timely calls to high-risk patients to assess health status and monitor outcomes.
• Arrange appropriate acute and follow-up care with PCPs and providers.
• Educate patients on disease processes, symptoms, and provider orders.
• Keep care team informed of pertinent findings and updates.
• Ensure prompt follow-up hospital visits to prevent readmission.

Skills

RN Case Management

Communication skills

Care coordination

Documentation

Education

BSN

RN License

Tools

EMR systems

Job description

Job Details

Job Location: 933 Pleasanton Rd - San Antonio, TX 78214 Position Type: Full Time Job Category: Hospice

General Summary

The RN Case Manager focuses on providing quality and continuity of care for our patients while reducing utilization costs. Responsibilities for this position include directing patients to timely, appropriate healthcare services based on the patients’ symptoms and medical conditions via phone. Providing Case Management services to GMG capitated patients that focus on providing care for patients who are high risk for frequent inpatient or ER encounters, and/or patients who need added expertise to guide them through a complex treatment plan.

Supervisory Responsibilities

This position has no supervisory responsibilities.

General Requirements

All duties performed will be done accurately and in a timely manner.

• Develop and maintain supportive, productive, and effective relationships with external and internal partners.
• Must have excellent written and verbal communication skills.
• Strong attention to detail and exceptional organizational skills.
• Maintain strict confidentiality of company, department, and patient information.
• Other duties as assigned.

Essential Job Responsibilities

1. 1. Assist in directing patient to the appropriate level / location of care. Based on history, symptoms, and provider advice by appointing patients with a GMG Provider, directing patients to Urgent Care or an Emergency Room, as needed, providing standard advice or provider’s specific directions to patient.
2. 2. Following approved triage protocol guidelines set forth by the organization.
3. 3. Maintain accurate database of GMG High Risk patients. Review High Risk census weekly to ensure it reflects appropriate high-risk patients, those who frequently have hospital admits/ER visits, and other highest risk patients for case management.
4. 4. Stratify patients in team meetings to define care needs and frequency for home visits by our High-Risk nurses or licensed Social Worker.
5. 5. Place timely calls to high-risk patients to assess their health status, ensure the treatment plans are being carried out, perform teaching, and monitor outcomes.
6. 6. Arrange appropriate acute care and follow up care with PCP, Intake, and other GMG Providers or Preferred Providers.
7. 7. Assist patients with medication orders, refills, diagnostics, and other services identified during the process.
8. 8. Educate patients in relation to the disease process, symptoms, treatments, and provider orders.
9. 9. Keep PCP, clinical and high-risk care team members informed of pertinent findings/issues.
10. 10. Update daily hospital census.
11. 11. Participate in physician communications (email, meetings, etc.) to keep tabs on clinical picture/plan for patient.
12. 12. Ensure that patients have prompt Hospital Follow up appointments to help prevent readmission. Assess discharge status, level of understanding and compliance; monitor attendance/ follow up on ‘no shows and cancellations.
13. 13. Attend Patient Care Committee and High-Risk Team meetings to provide follow up case management and other special care needs defined during PCC and HR Mtgs.
14. 14. Assist with other patients as needed to set up complex services that are needed acutely: SNF, Custodial Care, Psychiatric services, IV treatments, etc.
15. 15. Review HH/DME forms and ensure services are authorized before the provider’s sign/fax.
16. 16. Document appropriately in GMG computer systems, high risk database and other associated systems.
17. 17. Successfully meet care coordination and nurse triage production goals.

Education and Training

Minimum high school education or equivalent required. Graduation from an approved BSN program. Must be state-licensed RN with a minimum three years of RN experience, clinic experience preferred. Prior managed care experience preferred. Must have knowledge of medical terminology. Must have excellent customer service skills. Must keep all licenses and certifications current and in good standing as initial and continued employment is contingent up these credentials.

QualificationsExperience

Experience in a clinic, doctor’s office or hospital as a RN for at least three years preferred. Must have knowledge of medical terminology, anatomy, physiology. Familiarity with health care systems, regulations, policies, and functions. Must have a good understanding of documentation standards.

Other Requirements

• Computer Skills: Skilled in use of computer/EMR systems.
• Knowledge of Word processing software, spreadsheet software, Internet, and database software.

Work Environment

Depending upon the area assigned may be 100% clinical setting or office setting in a clinic environment. Exposure to communicable diseases, bodily fluids, toxic substances, ionizing radiation, medicinal preparations, and other conditions common to a clinic environment.

Mental / Physical Requirements

Requires manual dexterity, sitting, standing, stooping, reaching, kneeling, crouching, bending, walking, lifting up to 40 lbs. without assistance. Close vision and ability to adjust focus. Must be able to work efficiently under pressure.

Additional Information

Gonzaba Medical Group is seeking team members who contribute as A-Players, demonstrate a strong work ethic, are committed to the culture and our core values.

Other Duties As Assigned

The above job description is not intended to be an all-inclusive list of duties and standards of the position. Team members will follow any other instructions, and perform any other related duties, as assigned by their supervisor. Responsibilities, knowledge, skills, abilities, and work environments may change as needs evolve