RN CASE MANAGER-ABQ Full-Time PAC
Location: Albuquerque, New Mexico
Description: Presbyterian Healthcare Services is employing RN CASE MANAGER-ABQ Full-Time PAC right now, this position will be designated in New Mexico. Detailed specification about this position opportunity please read the description below. Minimum Skills/Requirements
Bachelors degree in Nursing, Business, or Health related field preferred. RN license required. Five years experienc! e in clinical nursing with a minimum of one to two in case management, utilization management, quality assurance, home care, community health, or occupational health. National certification preferred within 3 years of hire. Pediatric experience required. Computer knowledge to include Windows, Word, Excel, and database systems. Ability to analyze trends based on decision support systems. Business management skills to include, but not limited to, cost/benefit analysis, negotiation, & cost containment. Knowledge in referral coordination to community & private/public resources.
This position requires day travel within the 4 county area and will require visits to member homes.
Primary Job Functions
Primary Functions: • Identifies cases appropriate for care coordination.
- Conducts an in-depth assessment which includes, but is not limited to, psychosocial, physical, medical, environmental and financial parameters
- Develops, d! ocuments, and implements plan which provides appropriate resou! rces to address social, physical, mental, emotional, spiritual and supportive needs
- Formulates, implements, coordinates, monitors, and evaluates strategies for patients and families collaboratively with health care team.
- Collaborates with physicians, care providers, and ancillary support services to address care management issues for specific patients and disease processes.
- Applies utilization review criteria to assess and document the appropriateness of admission, continued stay, level of care, and readiness for discharge; refers cases that do not meet criteria to designated Physician Advisor.
- Collaborates with physician, caregivers, patient, family, and payer to pro-actively develop and implement discharge plan, as appropriate.
- Refers patients to appropriate inpatient, outpatient, and community resources.
- Advocates for members in caseload.
- Promotes the appropriate use of clinical and financial resources in ord! er to improve quality of care and patient satisfaction
- Performs cost-benefit analysis and negotiates rates with providers and vendors. Interfaces and negotiates with insurance companies and other payers to ensure payment for services.
- Actively participates in the development of clinical guidelines and pathways and incorporates processes into the role of nurse care coordinators.
- Educates providers and other PHS/PHP departments about care coordination services.
- Educates providers on health management strategies which can reduce need for one-on-one care coordination services.
- Facilitates a regional team approach to the coordination and cost effective delivery of quality care and services across the continuum.
- Generates reports, which demonstrate efficacy through direct cost-savings and outcome measures.
- Complies with Case Management Society of America Standards for Case Management Practice and with CCMC Code of Pro! fessional Conduct for Case Managers.
- Performs other functions ! as required.
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If you were eligible to this position, please send us your resume, with salary requirements and a resume to Presbyterian Healthcare Services.
Interested on this position, just click on the Apply button, you will be redirected to the official website
This position will be opened on: Sat, 20 Jul 2013 03:39:15 GMT
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