at Christiana Care Health System in Wilmington, Delaware, United States
- Coordinates the utilization of healthcare resources, including transition planning, facilitate the achievement of clinical, quality, financial and member satisfaction goals.
PRINCIPAL DUTIES AND RESPONSIBILITIES:
- Perform ongoing telephonic case management activities of assessment, problem identification, planning, implementation, coordination, monitoring, and evaluation of case managed members
- Collaborates with members, caregivers and members of the multi-disciplinary care team to develop a member centered plan of care to meet identified member care goals and outcomes
- Develop, implement, evaluate and revise case management care plans according to case management eligibility criteria, contractual guidelines and members physical and psychological needs throughout the continuum of care
- Identifies system issues that serve as barriers to care. Participates in development and implementation of strategies to remove barriers and promote resolution through coordination of a problem solving process
- Promote member wellness and autonomy through advocacy, communication, education, and identification and referral to community resources or other case management programs such as disease management programs
- Identify appropriate providers and facilities through the continuum of services, and ensure that available resources are being used in a timely and cost effective manner
- Collaborate with embedded and inpatient case managers in the discharge and transitional care process, obtaining and/or coordinating appropriate resources for members throughout the continuum of care
- Stratifies and/or validates member level of risk during each transition process and interaction with the member
- Collaborates with health care providers in settings not limited to the PCP office, hospital, skilled nursing facility or home care agencies to assist members in coordinating safe
transitions and enhanced communication of the treatment plan to all members of the multidisciplinary care team
- Makes referrals to the pharmacist, social worker, respiratory therapist or community outreach team as needed to provide holistic approach to care ensuring safe transitions of care and education
- Manages assigned case load in an efficient and effective manner utilizing time management skills to facilitate the total work process directly monitoring assigned members
- Demonstrates knowledge of utilization management and care coordination processes and current standards of care as a foundation for transition planning, complex case management and disease management activities
- Confers with Medical Directors regarding complex cases requiring physician input regarding the treatment plan or physician to treating physician collaboration
- Adheres to organizational and departmental policies and procedures and credentialed compliance
- Performs assigned work safely, adhering to established departmental safety rules and practices. Reports to supervisor, in a timely manner, any unsafe activities, conditions, hazards, or safety violations that may cause injury to oneself, other employees, members and visitors.
- Performs all other related duties as assigned by Manager/Director
EDUCATION AND EXPERIENCE REQUIREMENTS:
- Registered Nurse with BSN required or relevant experience in Utilization Management or Case Management
- Active DE RN Licensure, in good standing.
- Case Management Certification preferred through the Commission for Case Management (CCM) or within 18 months of hire after completion of 6 weeks of orientation
UPDATE: ChristianaCare is committed to prioritizing the health and safety of our patients and caregivers. As we continue to meet the needs of our caregivers and our community through the COVID-19 pandemic, our commitment to health and safety requires that we take new steps to ensure a safe environment for medical care for our patients and a workplace that avoids preventable harm for our caregivers. For this reason, vaccination for COVID-19 is required for all caregivers at ChristianaCare and is considered a safety standard that is job-related and consistent with business necessity for all caregivers.
Christiana Care Health System is an equal opportunity employer, firmly committed to prohibiting discrimination, whose staff is reflective of its community, and considers qualified applicants for open positions without regard to race, color, sex, religion, national origin, sexual orientation, genetic information, gender identity or expression, age, veteran status, disability, pregnancy, citizenship status, or any other characteristic protected under applicable federal, state, or local law.