Through early intervention, the Case Manager will apply the six essential
activities of Case Management to assure achievement of an individual's
maximum level of wellness. Via appropriate, quality, cost-effective
alternative care delivery, the Case Manager will explore community resources
and alternative funding in order to maximize health care benefit. The Case
Manager will assist an individual to self-direct and self-advocate thus
assurance of an informed and empowered healthcare consumer.
Essential Duties and Responsibilities:
* Acts as an advocate and approaches clientele, according to
his/her level of wellness, handicap, or injury with alternatives which may
improve his/her quality of life.
* Ethically engages in the six essential activities of the Case
Management process in order to assess, plan, implement, coordinate, monitor
and evaluate health care delivery.
* Applies six components of case management to each of the five
core areas: coordination/service delivery, physical/psychological factors,
benefit systems and cost analysis, case management concepts and community
* Practices case management within the full continuum of care
encompassing multiple environments.
* Interacts with all healthcare systems and continues involvement
with all participants to deal with an individual's broad spectrum of need.
* Applies CMSA standards of practice to an individual's holistic,
healthcare, occupational, psychosocial, cultural and financial need.
* Composes confidential, timely, report mechanisms that clearly
document goals, objectives, outcomes and cost benefit analysis.
* Acts as a resource to Utilization Review, Behavioral Health,
Disability and Case Management team members, committees, clientele and
Education and/or Experience:
* RN Degree or Diploma :current NH/PA license, RN licensure
within state of case management practice
* 3 years medical, surgical clinical experience: 3-5 years case
management or disease management experience. Case Management certification
Knowledge and skills:
* Excellent written/oral/communication skills.
* Intermediate Word, Excel computer skills.
* Demonstrated success as a case manager with basic Utilization
Review skills, Managed Care Software knowledge.
* Knowledge of the insurance industry, benefits coverage and
* Ability to apply the six components to the five core areas of
the case management process.
* Knowledge of case management principals, clinical guidelines,
and CMSA standards.
* Ability to prioritize caseload, combining comprehensive nursing
knowledge and skill with cost savings methodology and technique.
* Knowledge of health care providers, alternative funding and
community resources; ability to prioritize and utilize them efficiently
within the benefit plan.
* In depth knowledge of nursing care plans/skill and ability to
facilitate and coordinate transition of patients with catastrophic
injuries/illnesses through cost effective, medically appropriate,
alternative levels of care.
* Actively serves on an committee.
* Participates in in-service/provider education.
* Maintains membership and activity in a professional affiliation,
i.e. Case Management Society of America, Case Management Society of New
England, ANA in order to promote professional development within the
What we're looking for in an ideal case manager;
1. RN Degree or Diploma.
2. Current RN licensure.
3. 3+ years medical, surgical clinical experience.
4. 3+ years case management or disease management experience.
5. Case Management certification, CCM.
6. Local or within the Region.
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