Nurse Case Manager ( RN).ICF

Join a Team That Changes Lives

For more than 170 years, Elwyn has been leading the way in supporting children, teens, and adults with autism, intellectual and developmental disabilities, and behavioral health challenges. As a mission-driven nonprofit, we’re here to create real change – helping people lead meaningful, fulfilling lives.

Now, we’re looking for passionate team members to join us. Here, your work will change lives – including your own. You’ll make an impact every day, find purpose in what you do, and grow in a career that truly matters.

• At Elwyn, we take care of you while you care for others. We offer:
• Generous Paid Time Off
• Comprehensive Medical/Dental/Vision Benefit Packages
• Earned Wage Access/On-Demand Pay
• Paid On-the-Job Training
• Tuition Reimbursement
• Career Advancement Opportunities and Growth
• Flexible Schedules

Retirement Savings Plan

Join us and be a part of something bigger. Apply today.

Job Description

The Intermediate Care Facility (ICF), Nurse Case Manager supports other nursing team members and support staff in providing normalized, empathetic, therapeutic, and preventative health care to individuals with intellectual /developmental disabilities.

The Nurse Case Manager oversees the functions associated with managing the nursing needs of individuals in the ICF service line, care coordination, and the delivery of nursing services while ensuring that both regulatory and clinical practice standards are met. This position requires travel to various locations within the region.

Essential Duties and Responsibilities

Nurse Case Manager:

Ensures ongoing medical assessment, coordination, and interdisciplinary team collaboration that is necessary to meet client health care needs

Ensures that appropriate health care assessments and reports are accurate and completed by the interdisciplinary treatment team, per established policy and procedures, and ensures regulatory requirements through tasks including, but not limited to, intake assessment, and routine assessments for individuals on antipsychotics (including Abnormal Involuntary Movement Scale [AIMS], and applicable labs)

Collects data through direct observation, interview, clinical assessment, and records; presents updates to the psychiatrist and larger interdisciplinary team; attends and actively participates in Treatment Team Rounds

Sets health care priorities, including but not limited to medication administration, vital sign monitoring, and wound care in accordance with standard of care and professional judgment without jeopardizing the safety of the children

In collaboration with the larger interdisciplinary treatment team, monitors, develops, and maintains a safe and therapeutic living environment, including, but not limited to, monitoring for potential threats to health and safety and taking appropriate actions to eliminate such threats

Provides support of assigned staff in the areas including, but not limited to, leadership, coaching, training on health-related topics, medical procedures, and infection control as needed; assists with the training and orientation of new nursing employees; provide input regarding performance management

Ensures annual physicals are completed with the Primary Care Provider (PCP), and presents to the larger interdisciplinary team ensuring that all health care needs have been addressed to ensure quality of client care

• Ensures all after visit and discharge summaries are received in a timely manner;
• Collaborates with providers, pharmacists, and other healthcare professionals to ensure quality of client care

Reviews recommendations of consulting pharmacist and liaisons with providers and care providers for necessary follow-up including but not limited to medication changes, and altering medication administration times, to ensure continuity and quality of client care

Works closely with family members/legal guardians/health care decision-makers for the client supported in the ICF service line to identify, and communicate client health care needs, changes, and actions being taken to address them

Serves as a resource person for questions related to health and wellness issues (e. g. nutrition, exercise) around the quality of care of the clients served

Monitors provider's orders, Medication Administration Records (MARs), and relevant documentation to ensure that medications are properly and safely administered to reduce the risk of medication errors and injuries

Reviews critical incidents related to the health and safety needs of the client, and ensures that there is accurate, detailed, and timely follow-up and documentation of such via daily progress notes, communication to program staff, and communication, whether in person, via phone or through email, with the Charge Nurse for addition to the Charge Nurse Shift Report

Liaisons with external pharmacies, durable medical equipment (DME) providers, vendors, specialists, community-based providers, and insurers to ensure that client-specific needs are met in a clinically prudent and fiscally-sound manner

Assists in accessing community-based services and care providers, especially in emergency situations

Works with, understands, and complies with terms and conditions of collective bargaining agreements (CBA) within a unionized environment with tasks including but not limited to adherence to scheduling procedures, processing transfers and promotions, administering disciplinary actions, adjudicating grievances, where appropriate, etc.

• Utilizes quality improvement strategies to address the following:
• Clinical performance of nursing staff through monthly audits of nursing documentation and care delivery
• Use of best practice guidelines in promoting health maintenance and disease prevention strategies
• Compliance with regulatory standards as they relate to specific program areas, such as licensing regulations and current policy
• Access to high quality care consistent with individuals' specific needs
• Ensure that all program based medical and nursing equipment is clean, well kept, and in good working order, arranging replacement as needed
• Inventory of nutritional supplements, medical equipment, and medical/dietary supplies

Health Care Utilization Data

Completes assigned specific quality improvement activities/functions, such as medical record reviews or observations, to ensure compliance with regulatory standards

Reviews delegated quality improvement activities/functions, such as medical record reviews or observations, performed by nursing staff to ensure compliance with regulatory standards

Performs cardiopulmonary resuscitation (CPR), first aid, safe crisis intervention, and medication administration using agency-trained protocols

Provides round-the-clock on-call nursing support to assigned staff, via telephone communication, text, and/or email with the Charge Nurse, to manage emergent healthcare issues, including but not limited to possible infection, fainting, abnormal vital signs, vomiting, that occur during off hours

Provides weekend (Friday at 4:00pm to Monday at 8:00am) and holiday on-call coverage, as an on-call nurse leader to ensure quality of care for individuals; ensures that other nurse leader coverage is identified and communicated to the Media Campus Director of Nursing, Nursing Scheduler, and Medical Assistant/Office Manager, during periods of vacation and days off (other than Holidays and Weekends)

Staffing Nurse

Upon discharge, completes a Discharge Summary that includes all relevant medication, medical follow up, and pertinent health care information to provide for continuity of care

Completes hospital and Emergency Department transfer sheets, documentation to include but not limited to the annual physical exam, the last set of 90 Day Provider Orders, the current Medication Administration Records (MARs), and other pertinent information to the receiving facility to promote continuity of care

Prepares and administers medication, as ordered by the provider in accordance with Elwyn’s medication policies and procedures; obtains verbal orders when necessary and transcribes the information as per policy, and monitors weight and other vital signs of clients, as appropriate, as indicated by provider orders

Documents administration of prescribed medications and treatments on hard copy MARs or in an electronic format (eMARs); uses discretion during the administration of medications to provide as much client privacy as possible; adheres to Elwyn’s policies and procedures related to the Health Insurance Portability and Accountability Act (HIPAA), and the disclosure of health protected information

Instructs direct care staff, when appropriate, on the administration and documentation of specific treatments including but not limited to topical creams and other over the counter (OTCs) agents to ensure medication is administered as ordered

Evaluates the effectiveness of medications and treatments and report any observed side effects and relevant laboratory values to the provider; documents all behavioral and physical changes in the client’s status, including all changes from baseline status, and other pertinent information in the nursing progress notes; documents effectiveness of prescribed behavioral interventions and nursing actions, contacts the provider as needed and/or directed if there are abnormal side effects

Reviews the monthly MAR and validates that all medication and treatment orders are correct and up-to- date as needed; removes old MARs from the medication binder, if appropriate, and replaces them with new MARs at the start of every month for quality assurance purposes

Completes monthly medication exchanges with the pharmacy provider, conducting an immediate audit to reconcile any identified issues and/or shortages

Administers and documents immunizations as ordered by the provider; ensures that necessary patient consents have been completed prior to administration of the immunization

Prepares clients for medical appointments, and procedural preps through