RN Case Management Coord

Mercy-Health-System-Corporation; Janesville (WI); On-site; USD 64,000 - 97,000; Full time

Benefits offered by this job

Medical insurance

Dental insurance

Vision insurance

Life & Disability Insurance

FSA/HSA options

Paid time off

Job summary

Mercyhealth is seeking a registered nurse to perform case management duties within Wisconsin. You will gather information, assess needs, develop and implement a comprehensive care plan, and monitor progress to ensure optimal outcomes.

The role emphasizes NCQA/HEDIS knowledge, quality improvement, and collaboration with providers. RN licensure is required; BSN is preferred, and CCM certification is encouraged.

Qualifications

• Graduate of an accredited nursing program.
• RN licensure in state of practice.
• CCM certification or in process of obtaining certification.

Responsibilities

• Provide direct case management activities and develop comprehensive care plans.
• Assess patient needs and determine benefits/coverage based on medical policy.
• Coordinate resources and monitor progress to meet goals.
• Contribute to quality initiatives and NCQA/HEDIS compliance.

Skills

RN licensure

Case management

Quality improvement

Educator/consultation

Education

Nursing degree

BSN preferred

Job description

Essential Duties and ResponsibilitiesWill spend no less than sixty percent of time providing direct case management activitiesCollects in depth information about a person's situation and functions to identify individual needs in order to develop a comprehensive case management plan that will address those needs.Determines specific objectives, goals and actions designed to meet the clients' needs as identified through the assessment process; determines benefits/coverage of medical necessity based on MercyCare's medical certificate of coverageExecutes specific case management activities and or interventions that will lead to accomplishing the goals set forth in the case management plan.Organizes, integrates and modifies the resources necessary to accomplish the goals set forth in the case management planMonitors the ongoing process by gathering sufficient information from all relevant sources about the case management plan and its activities and determine the plans effectivenessEvaluates case managements effectiveness in reaching desired outcomes and goal and makes modifications or changes in the case management plan based on the evaluation.Participates as educator and resource person for provider offices and hospital staff as it pertains to the health plan case management policy and procedures.Will spend no more than forth percent of time coordinating and monitoring quality initiativeDemonstrates knowledge of NCQA and HEDIS Standards and participates in initiative to achieve accreditation and improve HEDIS compliance ratesAbility to assist with performing of case/barrier analysis, baseline study analysis and create Quality -Improvement studies and sound study design and interventionsAssists in the gathering and analysis of dataInsures that all activities are internal and external customer focused, well planned, organized and controlled to assure the cost effectiveness of all programs.Assists in the staff support activities of the UM/QI Committees and other special projects or tasks as assigned by the Medical Director or DirectorAssists with developing and updating policy and procedures for the Quality Health Management Policy and Procedure ManualEducation and ExperienceGraduate of an accredited nursing program.BSN or upon hire BSN completion agreement for enrollment in an accredited BSN Completion ProgramMay require specific years of applicable experience to qualify per department guidelines. If hired prior to 1-1-14 in Winnebago County and prior to 9-1-14 in Rock, Walworth and McHenry Counties an ADN only is required.ADN RN or RN Diploma Degree preferred two years related experience.Certification and LicensureLicensed as an RN in state of practiceCertified Case Manager CCM or in the process of obtaining case manager designationPAY RANGE:$63,644.48 - $97,376.06Mercyhealth is an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identify, national origin, disability, or protected veteran status.Mercyhealth offers competitive pay and a comprehensive benefits package including:Medical, Dental, VisionLife & Disability InsuranceFSA/HSA OptionsGenerous, accruing paid time offPaid Parental and caregiver leaveCareer advancement and educational opportunitiesTuition and certification reimbursementCertification ReimbursementWell-being ProgramsEmployee DiscountsOn-Demand PayFinancial EducationAnnual recognition/awards eventsPartner appreciation daysFamily entertainment/attractions discountCommunity service/improvement opportunitiesClick here for more details regarding Mercyhealth Careers Benefit Information.At Mercyhealth, we don’t simply hire people, we empower employee-partners who are passionate about making lives better. As an integrated health system, we deliver exceptional, coordinated across seven hospitals, 85 primary and specialty clinics, and a team of over 7,500 professionals serving northern Illinois and southern Wisconsin.Mercyhealth has been nationally recognized for our commitment to our people and culture, including:#1 in the nation on AARP's Best Employers for Workers Over 50One of Working Mother magazine's 100 Best Companies for Working MothersA Top 50 Company and Top 10 Nonprofit for Executive Women