RN Care Manager

Washington, DC, United States

Job Description - RN Care Manager (240000PY)

Job Description

RN Care Manager

-

(

240000PY

)

Description

Description

Under the direction of the Senior Care Manager, the RN Care Manager (CM) is responsible for providing comprehensive care coordination services to members with high complexity medical and behavioral needs who are enrolled in the Health Services for Children with Special Needs (HSCSN) health plan. This CM will have a caseload of medically fragile members with a focus on medical intervention and associated care coordination needs outlined by the member assigned acuity level. The CM routinely communicates with members on their assigned caseload to assess their needs; develop, monitor and evaluate treatment plan progress; and assist with coordinating care and referring to appropriate services for members who have highly complex medical and psychosocial needs.

Qualifications

Minimum Education

Associate's Degree in Nursing (Required)

Bachelor's Degree in Nursing (Preferred)

Minimum Work Experience

2 years Two or more years of healthcare or related experience in case management, disease management, or managed care. (Required)

Required Skills/Knowledge

Effective verbal and written communication skills

Bilingual (Spanish speaking) preferred

Familiar with medical terminology

Familiarity with computer systems and applications, particularly in Microsoft Office suite

Strong organizational skills

Ability to interpret and apply departmental requirements

Ability to make sound decisions and use good judgment

Ability to work under pressure and meet deadlines, while maintaining a positive attitude and providing exemplary customer service

Ability to participate in professional, multidisciplinary meetings to include internal and external staff meetings

Required Licenses and Certifications

Registered Nurse in District of Columbia (Required)

Job Functions

Essential job duties:

Manages a caseload as outlined by CASSIP and Care Management Leadership.

Maintains compliance in accordance with contractual and care management requirements

Assists in research, and implementation of disease management/population health programs to serve our highest complexity members.

Conducts outreach and face-to-face visits at a frequency no less than determined by the enrollee’s assigned stratification level or more if needed, with each enrollee/caregiver in their homes, physician’s offices, or other mutually agreed upon locations.

Assesses enrollees on enrollment and at intervals no less than determined by the enrollee’s stratification level to identify needs/barriers and close gaps in care.

Identifies over/under utilization promptly, and takes appropriate action according to organizational policy.

Upon gathering health and mental/behavioral health, environmental, psychosocial and educational information, the CM develops, implements, and updates an accurate individualized comprehensive care coordination plan for each assigned enrollee in collaboration with the PCP and/or other multi-disciplinary team members including public agencies.

Completes routine care coordination and care management activities with attention to quality, timeliness and in compliance with company policy and national standards.

Consults with Senior Care Manager to review and prioritize cases, set objectives, identify, and report potential risk and utilization concerns.

Accurately and timely documents enrollee findings and interactions according to organizational policy.

Understands and abides by HSCSN’s Confidentiality policy and procedure regarding enrollee specific information.

Participates in disposition and discharge planning activities. Contributes to the discharge plan in a timely manner, taking into consideration enrollee/family/significant others and match to healthcare resources.

Clearly and respectfully communicates verbally and in writing.

Assists/empowers caregivers or enrollees to participate in care of child /self.

Assists assigned enrollees and their caregivers in understanding the importance of EPSDT and compliance with all health services. Strives to achieve target rate of compliance for preventive medical and dental services.

Assists with scheduling and monitors the compliance of mental health/medical appointments. Follows department policies for identifying and reporting noncompliance, missed appointments, and other reportable incidents including communication to primary care provider or specialist.

Applies advanced knowledge of conditions of target population/standard approaches to care management and care coordination to assigned enrollees.

Attend multidisciplinary meetings as necessary, including off-site meetings with other involved agencies.

Receives and reviews reports of visits by vendors or contracted providers to enrollees receiving services and facilitates coordination of follow-up care, as needed.

Refers enrollee/caregiver to appropriate vendor(s) on DME/assistive technology use. Educates on medication administration, about their conditions, and techniques for self-management within the scope of license. Refer, as needed, to appropriate vendor for additional education.

Assist enrollees in planning for transitions of care to include but not limited to transitioning from Early Intervention to DCPS; from pediatric to adult providers; transitioning out of HSCSN when the enrollee ages out or is disenrolled for any reason; from outpatient to inpatient or the reverse; and entering or exiting the custody of CFSA, DYRS or any type of institutional care.

Enters authorizations for services requiring authorization by Care Management staff.

Keeps abreast of changing strategies and trends in care coordination and care management.

Uses communication skills which promote understanding and collaboration with enrollees and their families, HSCSN staff, providers and others.

Positively presents accurate information about HSCSN to enrollees and their families, HSCSN staff, providers, coworkers and the community.

Maintains professional, courteous and customer focused demeanor in all interactions.

Demonstrates knowledge of medical terminology and health care delivery systems.

Applies time management and organizational skills effectively.

Other job duties:

May perform other duties in addition to those outlined in this job description.

Organizational Accountabilities

Organizational Accountabilities (Staff)

Employee Excellence

Demonstrates understanding of quality of service and collaborates with co-workers to ensure excellence standard is achieved

Innovates through improvement of care and/or efficiency of operational processes.

Dedicated to a standard of performance excellence and high quality

All In

Embraces changes/improvements and actively participates in the implementation of new/improved programs, technology, new equipment, systems and resources that promote quality of care, safety and efficiency

Identifies, prioritizes and selects alternative solutions to determine best outcome

Action Oriented

Maintains a high level of activity/productivity, meeting deadlines and appropriately prioritizing tasks to meet business demands

Anticipates problems and attempts to solve before they develop

Supervisory Responsibilities

None

Category III: Job does not involve exposure to blood, body fluids, non-intact skin or tissue specimens. Incumbent does not perform or help in emergency medical care or first aid as a part of his/her job.

Protected Health Information Access Level

Level IV - Full Access Incumbents in this job may access any protected health information associated to a customer's needs, the service(s) rendered and the position's functions.

This job operates in an office environment.

Physical Requirements

Sedentary Work: Lifting 10 lbs. maximum and occasionally lifting and/or carrying such articles as dockets, ledgers and small tools. Although a sedentary job is defined as one that involves sitting, a certain amount of walking and standing is often necessary in carrying out job duties. Jobs are sedentary if walking and standing are required only occasionally and other sedentary criteria are met.

Travel Requirements

None

DC Residents Encouraged to Apply

Primary Location

Primary Location

:

District of Columbia-Washington

Work Locations

Work Locations

:

HSCSN - MLK Ave

3400 Martin Luther King Jr. Ave SE

Washington

20032

Job

Job

:

Nursing

Organization

Organization

:

HSC W/Special Needs

Position Status

:

R (Regular)

-

FT - Full-Time

Shift

:

Day

Work Schedule

:

40

Job Posting

Job Posting

:

Apr 25, 2024, 8:58:09 PM

Health Services for Children with Special Needs (HSCSN) is an equal opportunity employer that evaluates qualified applicants without regard to race, color, national origin, religion, sex, age, marital status, disability, veteran status, sexual orientation, gender, identity, or other characteristics protected by law. The “Know Your Rights” poster is available here: and the pay transparency policy is available here:Know Your Rights Pay Transparency Nondiscrimination Poster

Please note that it is the policy of Health Services for Children with Special Needs (HSCSN) to ensure a “drug-free” work environment: a workplace free from the illegal use, possession or distribution of controlled substances (as defined in the Controlled Substances Act), or the misuse of legal substances, by all staff (management, employees and contractors). Though recreational and medical marijuana are now legal in the District of Columbia, Children's National and its affiliates maintain the right, in accordance with our policy, to enforce a drug-free workplace, including prohibiting recreational or prescribed marijuana.

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