Reporting directly to the Clinic Manager, the Nurse Case Manager is responsible for coordinating the care and services of CIBD patients across the continuum of illness; promoting and monitoring the effective utilization of health care resources; and assuming a leadership role with the multi-disciplinary care team to achieve optimal clinical and resource outcomes. Additionally, providing Team Center Care in a collaborative setting in accordance with the standards and regulations for California Children’s Services (CCS), Genetically Handicapped Persons Program (GHPP) and all other State and Federally sponsored programs. The Nurse Case Manager works as part of the Case Management Team.
ESSENTIAL JOB DUTIES
Works with patients to understand their needs and coordinates their care with outside facilities including but not limited to home health agencies, third party payers, pharmacies, lab facilities, etc.
Works with the physicians, nurses and authorization coordinator within CIBD to ensure proper follow-through on orders and to coordinate their completion including patient understanding of the results.
Works with home health agencies, third party payers, pharmacies, lab facilities and other outside providers to establish and maintain optimum care for CIBD patients.
Demonstrates strong organizational and documentation skills. Keeps tracks of all care and interactions with patients and outside facilities and documents those within the patient’s chart.
Demonstrates effective written and verbal communications skills; critical thinking and problem solving skills; ability to resolve conflicts, including situations where there may be conflicting priorities. Responds to the needs of the patients and educates them how to resolve any issues.
Develops standards of care coordination that demonstrate success in promoting high quality, cost effective delivery of care. Develops care guidelines and educates the clinical team and patient on them.
Promotes a comprehensive care team model and becomes cross-trained as necessary to provide staffing support as needed.
Demonstrates the ability to be self-directed and work effectively with others at all levels. Identifies organizational needs and takes initiative to resolve them.
Acts as a liaison to providers, patients and staff and exhibits effective communications to maintain excellent interpersonal relationships.
Assumes full or partial responsibility for projects designed to support the CIBD’s mission.
Attends appropriate training, seminars and workshops as required.
Performs related duties as required.
Required Education, Experience, Skills:
Graduation from an accredited school of Registered Nursing. Will consider Licensed Vocational Nurse with strong Case Management skills.
Nursing experience in acute care or ambulatory setting.
Licensure, Certification, Registration:
Current California RN License
Basic Life Support
Knowledge of CCS/GHPP/Medi-Cal regulations and requirements.
Understanding of third party payer methods and regulations.
Previous Case Management Experience in an outpatient setting.
Hematology nursing experience in an adult or pediatric setting.
Bilingual; Spanish speaking
Required Knowledge, Skills and Abilities: Proficiency and ability to effectively use Windows MS Word, MS Excel, MS Outlook, MS Internet Explorer, facsimile machines, copiers, scanners and database software.
Proficiency and ability to effectively use MS Publisher and MS PowerPoint as needed.
Proficiency with Electronic Medical Record databases.
Willingness and ability to maintain appropriate level of confidentiality and privacy. Ability to effectively handle multiple items or tasks as required and adapt to changing priorities.
Ability to effectively prioritize items / tasks as required.
Ability to work effectively with people of diverse cultures, ages and backgrounds.
Excellent organizational skills to manage many competing timetables and responsibilities
Current California driver’s license required insurance when using personal vehicle on Center business.
A keen appreciation and understanding of the CIBD’s mission and philosophy including the ability to:
Creating a professional environment that supports the mission, goals and values and the success of the organization through active participation and cooperation with team members Improving public health
Continuous professional development