RN CASE MANAGER

Position Description

The Registered Nurse (RN) provides case management to NVHC patients within a Patient Centered Health Home (PCHH) environment. The nurse will provide population management, wellness promotion, disease prevention and chronic disease management for a select group of patients in a service area.

In addition, will provide ongoing support and expertise through comprehensive assessment, planning, implementation and overall evaluation of individual patient needs. In keeping with applicable Nevada Revised Statues (NRS) and the Nevada Administrative Code (NAC).

The overall goal of the position is to enhance the quality of patient management and satisfaction, to promote continuity of care and cost effectiveness through integrating functions of case management to meet the specific needs of the patient.

Minimum Qualifications

• Graduate of an accredited nursing school required. Bachelor’s degree in nursing preferred
• Licensure as a registered nurse in the state of Nevada required
• Current CPR or BLS certification required
• Minimum three years of experience in a clinical practice, ER, ICU with good clinical skills
• Familiarity with Electronic Health Record systems required

Essential Duties and Reponsibilities

Responsible for the case management of the member population who are eligible for and require continuous, chronic and/or high intensive level of case management.

• Provides health education and coaches patients in a service area on treatment alternatives to assist them in best decision-making.
• Supports patients in selection of best physician and facility to maximize access, quality, and to manage health care costs. Coordinates services and referrals to health programs. Takes in-bound calls and places out-bound calls as dictated by patient and business needs.
• Track and support patients when they obtain services outside the practice. Identify potentially unnecessary services and care delivery settings and recommend alternatives if appropriate by analyzing clinical protocols. Case managers will use data reports and medicals records to identify patients who are “disconnect” in the system and proactively connect them to the right healthcare options.
• Follow-up with patients in a service area within a few days of an emergency room visit or hospital discharge. Provide care management services for high-risk patients. Examine clinical programs information to identify members for specific case management and/or disease management activities or interventions by utilizing established screening criteria.
• Identify clients at the highest risk who offer the greatest potential for improvements in health outcomes.
• Manage network participation, care with specialty networks, care with DME providers and transfers to alternative levels of care using knowledge of benefit plan design.
• Special projects, initiative, and other job duties as assigned.
• Patient encounters as needed.
• Other duties and special projects as assigned

Desired Knowledge, Skills & Abilities

• Prior clinical experience preferably in an ambulatory setting, acute care, skilled or rehabilitation clinical setting
• Excellent people skills and customer service acume
• Ability to work independently under general instructions and with a team
• Valid drivers license and/or dependable transportation necessary.
• Previous experience in Case Management or Utilization Management
• Knowledge of office lab procedures; pediatric and adult phlebotomy skills
• Knowledge and skill in pediatric and adult medication and immunization administration
• Knowledge of the essential functions, practices and procedures of a medical clinic and office
• Knowledge of in office procedures
• Ability to interact effectively and positively with other staff members
• Detail oriented and ability to handle multiple and shifting priorities
• Excellent ability to problem solve, deescalate/resolve conflict and perform service recovery.
• Ability to effectively utilize AIDET tool set
• Demonstrated ability to produce high quality work in a consistent manner
• Demonstrated ability to manage timelines and projects successfully
• Computer literate, with ability to prepare complex reports and analysis

NVHC’s Equal Employment Opportunity Statement

Nevada Health Centers will provide equal opportunity employment to all employees and applicants for employment. No person shall be discriminated against in employment because of race, color, gender, age, national origin, ancestry, religion, physical or intellectual disability marital status, parental status, sexual orientation or any other category protected by law.

Americans with Disabilities Act (ADA) Statement

Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

While performing the duties of this job, the employee is regularly required to stand and walk for prolonged periods of time in an ambulatory patient care setting; use hands to finger, handle, or feel; reach with hands and arms; and talk or hear.

The employee is regularly required to stand; walk; stoop, kneel, or crouch. The employee must regularly lift and/or move up to 20 pounds.