Job Description Type of Opportunity: Full Time FTE: 1.000000 Exempt: Yes Work Schedule: Weekday Schedule Monday-Friday
Location: Clinic based position - will assist patients via: clinic, home, and telephonic.
The RN Case Manager is responsible for facilitating the most appropriate level of care for the patient. The role integrates utilization management, care coordination, and transition planning functions. The Case Manager has the overall accountability for a designated case load and plans effectively in order to meet patient’s needs, manage the length of treatement, and promote efficient utilization of resources. In addition, mentor the healthcare team on cost-effective and medically appropriate alternatives.
- Facilitates a team approach, including the Interdisciplinary Care Plan team, to ensure appropriate interventions, cost effective delivery of quality care and services across the continuum. Collaborates with the Interdisciplinary Care Plan Team which may include member, caregivers, members legal representative, physician, care providers, and ancillary support services to address care issues, specific member needs and disease processes whether, medical, behavioral, social, community based or long term care services.
- Conducts in depth health risk assessment and/or comprehensive needs assessment which include, but not limited to psycho-social, physical, medical, behavioral, environmental, and financial parameters.
- Provides care coordination to members with chronic or complex conditions which require intensive interventions and oversight include multiple, clinical, social and community resources. Implements, coordinates, and monitors strategies for members and families to improve health and quality of life outcomes. Develops, documents and implements plan which provides appropriate resources to address social, physical, mental, emotional, spiritual and supportive needs. Acts as an advocate for members care needs by identifying and addressing gaps in care. Performs ongoing monitoring of the plan of care to evaluate effectiveness. Measures the effectiveness of interventions as identified in the members care plan.
- Develops and communicates plan for authorization of services, and serves as point of contact to ensure services are rendered appropriately, (i.e. during transition to home care, back up plans, community based services).
- Conducts face to face home visits, as required.
- Assesses and reviews plan of care regularly to identify gaps in care, trends to improve health and quality of life outcomes; collects clinical path variance data that indicates potential areas for improvement of case and services provided; works with members and the interdisciplinary care plan team to adjust plan of care, when necessary.
- Promotes the appropriate use of clinical and financial resources in order to improve the quality of care and member satisfaction. Generates reports in accordance with care coordination goals.
- Educates providers, support staff, members and families regarding care coordination role and health strategies with a focus on member-focused approach to care. Facilitates a team approach to the coordination and cost effective delivery to quality care and services.
- Provides assistance to members with questions and concerns regarding care, providers or delivery system.
- Maintains professional relationship with external stakeholders, such as inpatient, outpatient and community resources.
- May assist with orientation and continued mentoring of team members as appropriate.
- Performs other functions as required.
Credentials:* Registered Nurse or* Licensed Clinical Social Worker
* Licensed Master Social Worker
* Must have a valid driver license, clean driving record and able to travel locally.
Education: Associates Degree in Nursing plus 3 years of related experience. Bachelors Degree and six years of related experience preferred.
Experience: Utilization management, quality assurance, home care, community health, long term care or occupational health required. Proficiency in Microsoft Word, Excel and Outlook. Knowledge of referral coordination to community & private/public resources.
Benefits are effective day-one (for .45 FTE and above) and include:
- Competitive salaries
- Full medical, dental and vision insurance
- Flexible spending accounts (FSAs)
- Free wellness programs
- Paid time off (PTO)
- Retirement plans, including matching employer contributions
- Continuing education and career development opportunities
- Life insurance and short/long term disability programs
About Us Presbyterian Healthcare Services is a locally owned, not-for-profit healthcare system of nine hospitals, a statewide health plan and a growing multi-specialty medical group. Founded in New Mexico in 1908, it is the state's largest private employer with approximately 11,000 employees.
Presbyterian's story is really the story of the remarkable people who have chosen to work here. Starting with Reverend Cooper who began our journey in 1908, the hard work of thousands of physicians, employees, board members, and other volunteers brought Presbyterian from a tiny tuberculosis sanatorium to a statewide healthcare system, serving more than 700,000 New Mexicans. We are part of New Mexico's history - and committed to its future. That is why we will continue to work just as hard and care just as deeply to serve New Mexico for years to come. About New Mexico New Mexico's unique blend of Spanish, Mexican and Native American influences contribute to a culturally rich lifestyle. Add in Albuquerque's International Balloon Fiesta, Los Alamos' nuclear scientists, Roswell's visitors from outer space, and Santa Fe's artists, and you get an eclectic mix of people, places and experiences that make this state great. Cities in New Mexico are continually ranked among the nation's best places to work and live by Forbes magazine, Kiplinger's Personal Finance, and other corporate and government relocation managers like Worldwide ERC. New Mexico offers endless recreational opportunities to explore, and enjoy an active lifestyle. Venture off the beaten path, challenge your body in the elements, or open yourself up to the expansive sky. From hiking, golfing and biking to skiing, snowboarding and boating, it's all available among our beautiful wonders of the west. AA/EOE/VET/DISABLED. PHS is a drug-free and tobacco-free employer with smoke free campuses.