RN Case Manager

Job description

HealthPartners is hiring an RN Case Manager. This position exists to provide support to patients, their families, and physicians in addressing medical and social concerns; educate and empower patients and families to make informed personal health care decisions; and facilitate communication between patient, physician, health plan and community.
This is a primarily remote position that includes several in-person member visits each week in homes, healthcare facilities, and other community settings throughout the Metro area.
ACCOUNTABILITIES :
• Member Focus
• Ensures all activities are member-focused and individualized, resulting in personalized attention to each patient’s unique needs.
• Identifies interventions and resources to assist member reaching personal health related goals.
• Identifies patterns and episodes of care that are predictive of future needs and services.
• Integration
• Integrates clinical and psychosocial information for case identification and individual patient assessment to develop action-oriented and time-specific planning and implementation of appropriate interventions.
• Facilitates integration of patient care by encouragement of effective communications between patients, families, providers, health plan and care system programs, and community-based services.
• Adheres to department policy and procedure in daily activities.
• Coordinates service coverage with appropriate funding sources when indicated.
• Works with Supervisor, Case Management, Government Programs department and Member Services department to ensure compliance with Medicare requirements and regulations.
• Communication
• Effectively communicates with patients and their families to provide them with a better understanding of their health, health care benefits, and health care system.
• Effectively and routinely communicates with patients, families, physicians and health care team members to facilitate successful collaboration resulting in high levels of member/patient/family/provider satisfaction.
• Provides educational information and materials to members to support preference sensitive decisions.
• Provides regular reporting of member outcomes to Case Management leadership according to defined process.
• Identifies and promptly reports potentially adverse situations to leadership as outlined in department policy and procedure.
• Identifies and promptly reports high cost cases for reinsurance.
• Maintains current and accurate documentation and case management files in accordance with Case Management policy and procedure.
• Maintains confidentiality of information in accordance with department and corporate policies.
• Relationships and Team Building
• Establishes and maintains good working relationships within the Case Management department, with other HealthPartners departments, and with other health team participants.
• Supports other team members in achieving patient centered goals.
• Assists supervisor in maintaining a cohesive Case Management team by contributing to a collaborative, respectful, and diverse environment.
• Participates in and contributes to appropriate departmental and/or organizational meetings.
• Technology
• Maintains knowledge of and effectively uses automated applications and systems.
• Identifies deficits in technological literacy and seeks appropriate training under guidance of supervisor.
• Maintains maximum individual productivity through proficient use of automated systems.
• Personal Development
• Participates in ongoing independent study and education-related professional activities to maintain and increase knowledge in the areas of Case Management, patient care services, and benefit packages for development of effective case management skills.
• Demonstrates responsiveness to and appreciation of constructive feedback and recommendations for personal growth and development.
• Maintains current, active Minnesota nursing licensure.
• May maintain current, active nursing licensure in other states as assigned.
• Other Duties
• Willingly participates in various committees, task forces, projects, and quality improvement teams, as needed and assigned.
• Performs other duties as assigned.

CURRENT DIMENSION:
• Directly reports to Supervisor, Case Management.
• Directly manages caseload with anticipation of up to 85 members with complex needs.
• Interacts with medical, administrative, and front line staff within and outside the organization in order to collaborate on members care.

REQUIRED QUALIFICATIONS :
• Registered Nurse with current unrestricted license in the State of Minnesota, BSN preferred. License free of history of restrictions and/or sanctions in the past 10 years in all states with current or past licensure.
• Minimum of 3 years clinical practice experience in an acute care setting; minimum of 3 years relevant utilization review, discharge planning, or case management experience; and current clinical knowledge.
• Demonstrated effective, independent nursing judgment and skills.
• Demonstrated skill and experience in effectively collaborating with care team members, using a high level of expertise in written, oral and interpersonal communication.
• Demonstrated working knowledge of quality improvement, utilization management, benefit plans, fiscal management, and various payment methodologies preferred. Understanding of healthcare and/or HMO industry.
• Demonstrated skill in effective use and management of automated medical management systems.
• Demonstrated flexibility, organization, and appropriate decision-making under challenging situations.
• Basic computer skills

CHALLENGES:
• Maintaining member focus in a rapidly evolving environment.
• Influencing team members and colleagues to work collaboratively in achieving the goals and objectives of the Case Management Program.
• Contributing a positive team building approach as a member of the Case Management team, and a global member of the Case Management Department.

DECISION-MAKING :
• Makes independent decisions within the scope of this position’s accountabilities and determines the need for and the timing of consultation with Case Management leadership and/or Medical Director.
• Uses professional clinical judgment, organizational knowledge, industry knowledge, and common sense in determining appropriate alternatives for members/patients/families, consulting with leadership and/or Medical Director, when indicated.
• Makes recommendations to leadership regarding policy development needs and/or changes.