Registered Nurse-Nurse Case Manager-CCM Job in San Mateo 94404, California US
Job Purpose: To conduct telephonic and on-site case management and in a collaborative process of assessment, planning, facilitation and advocacy for options and services required to meet an individuals heath needs, using communication and available resources to prevent readmissions and promote quality, cost-effective outcomes.
Job Results: Builds effective business relationships with members and other internal and external partners by using excellent verbal and written communication skills, developing trust, meeting timelines, respecting cultural differences, using active listening skills, and maintaining confidentiality.
Selects appropriate cases to open by screening from internal or external referral sources and applying criteria for opening cases consistently.
Manages cases by using essential activities of case management including assessment, planning implementation, coordination, monitoring and evaluation.
Promotes patient empowerment during care transitions by assisting the patients/caregiver to develop skills to advocate for themselves.
Participates in meeting the Care Transitions goals of empowering the member/caregiver to advocate for themselves resulting in adverting hospital re-admissions within 30 days of discharge by consistently applying the Care Transitions Program content.
Facilitates member care being delivered at the right level, right place, right time according to the benefit plan by acting as a resource to case managers, physicians and other members health care team providers.
Assists member/caregiver in end of life wishes by providing information and referral sources related to advanced care planning and advanced directives.
Timely written documentation shows evidence of all CCM and Care Transitions activities and provides a status of the case for all of the internal case management team.
Facilitates qualify of care and service by referring any potential quality issue to the Medical Director and Quality Management Department.
Maintains professional and technical knowledge by attending educational workshops; reviewing professional publications; establishing personal networks; participating in professional societies.
Contributes to team effort by accomplishing related results as needed.
Registered Nurse (Current and active California RN license in good standing)Case Management Certification preferred.
Three to five years experience in medical-surgical nursing.
Three years concurrent review / case management experience in the managed care industry required.
Types 40+ WPM, excellent grammar, spelling, and punctuation skills.
Proficient in Windows based applications, MS Word Proficient in keying data in Excel Strong written and verbal communication skills.
Excellent organizational skills.
Ability to prioritize work assignments.
Ability to handle multiple tasks simultaneously.
Ability to work with minimum supervision.
Ability to complete assignments when due. Abe GhebrehiwetSenior Account ExecutiveNurse Resolutions888.
411.2228. Toll Free407.
341.9647. Cell407.557.2270.
Faxwww.NurseResolutions.com Abe [at] NurseResolutions [dot] com
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