Case Manager RN Falls Church Medical Center Falls Church, VA
For members of a defined population, the nurse case manager is responsible for coordination of appropriate, cost-effective services that enhance a member's quality of life, focus on a member's optimal level of independence, and reduces inappropriate utilization of medical services.
- In close collaboration with the member/member's family, and the multidisciplinary Health Care Team (Primary Care Physicians, Specialty Physicians, and other members of the health plan, the network and the community), assesses the member's health status, functional limitations, psychological status, social support systems, resources, environmental factors, and response to treatment.
- Plans, implements, manages, coordinates and evaluates a comprehensive plan of care across the care continuum aimed at stabilizing chronic or high risk medical conditions and ensuring appropriate use of medical services and resources. Effectively manages and coordinates assigned caseload consistent with established criteria.
- Develops, implements, and manages the patient's plan of care through use of comprehensive assessment tools, processes, clinical pathways, and clinical guidelines to evaluate patient's plan of care, including processes to identify and correct deviations from clinical pathways. Identifies and analyzes trends and barriers that may affect patient outcomes.
- Coordinates, manages, and evaluates services to ensure that they are consistent with the comprehensive plan of care and are delivered in a manner that demonstrates high quality and cost effectiveness.
- Ensures consistent and reliable documentation of case management activities in compliance with all organization and department standards. Practices within ethical and legal guidelines using established policies and procedures. Maintains confidentiality of patient records, information, and departmental activities involving patient information.
- Analyzes patient and program outcomes to identify improvements in program, quality and cost effectiveness of case management activities.
- Develops, implements, and manages case finding and screening processes to identify candidates for case management and to define the appropriate level of case management for members.
- Actively participates in the referral processes, including eligibility verification, compliance with medical necessity guidelines, and evaluation of outcomes, ensuring that the appropriate information is entered into all relevant data systems.
- Provides education and consulting services to members, families and caregivers, members of the healthcare team, the health plan staff, and the community.
- Promotes self-awareness and knowledge of current medical and case management standards in the community, recent innovations in patient care, and availability of alternative community, local, state, and federal resources.
- Three (3) years of clinical experience plus two (2) years of experience in case management are required.
- Bachelor's degree is required. Two (2) additional years of related specialty experience may be substituted for degree requirement.
License, Certification, Registration
- Current RN licensure in assigned jurisdiction is required.
- Case management or specialty certification is required (or acquired within three years of employment in this position).
- Additional years of relevant clinical experience may be substituted for the case management experience requirement. Required clinical experience must include at least one (1) year in area of specialty as follows:
- Geriatric: One (1) year of recent experience with a geriatric and Medicare population is required. Experience with chronic and/or high-risk medical diseases is required, including but not limited to diabetes, CHF, Alzheimer's, dementia, CVA.
- Pediatric/Adolescent: One (1) year of recent experience with pediatric/adolescent population is required. (Experience with chronic and/or high-risk medical diseases is preferred, including but not limited to asthma, cystic fibrosis, cerebral palsy.)
- Adult: One (1) year of recent primary care experience with an adult population is required. (Experience with chronic and/or high-risk medical diseases is preferred, including but not limited to diabetes, CHF, COPD, asthma.)
- Perinatal: One (1) year of recent labor and delivery of predominately high-risk obstetrics is required. (Four (4) years of labor and delivery experience in a high-risk setting are preferred.) Demonstrated competence with medication management is required.
- Oncology: One (1) year of recent clinical oncology experience is required (hospice certification preferred.)
- Renal: One (1) year of recent nephrology nursing experience is required. (Two (2) years of recent dialysis nursing experience are preferred.) Demonstrated competence with vascular access management is required.
- Experience with computer software programs in a Windows environment is preferred.
- Master's degree is preferred.
- Knowledge of regulatory issues for the Mid-Atlantic area is preferred.
Primary Location: Virginia,Falls Church,Falls Church Medical Center 201 N. Washington St.
Scheduled Hours (1-40): 40
Working Days: Mon-Fri
Job Type: Standard
Employee Status: Regular
Employee Group: UFCW - Local 400
Job Level: Individual Contributor
Job: Nursing Licensed
Public Department Name: Outpatient Continuing Care
External hires must pass a background check/drug screen. Qualified applicants with arrest and/or conviction records will be considered for employment in a manner consistent with Federal, state and local laws, including but not limited to the San Francisco Fair Chance Ordinance. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, sexual orientation, gender identity, protected veteran, or disability status.
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