RN Case Manager

HealthCare Support Staffing, Inc. (HSS), is a proven industry-leading national healthcare recruiting and staffing firm. HSS has a proven history of placing talented healthcare professionals in clinical and non-clinical positions with some of the largest and most prestigious healthcare facilities including: Fortune 100 Health Plans, Mail Order Pharmacies, Medical Billing Centers, Hospitals, Laboratories, Surgery Centers, Private Practices, and many other healthcare facilities throughout the United States. HealthCare Support Staffing maintains strong relationships with top providers in healthcare and can assure healthcare professionals they will receive fast access to great career opportunities that best fit their expertise. Connect with one of our Professional Recruiting Consultants today to see how a conversation can turn into a long-lasting and rewarding career!

• Coordinates the care and services of Long Term Care members across the continuum of illness. Promotes effective utilization and monitors health care resources. Assumes a leadership role within the interdisciplinary team to achieve optimal clinical and resource outcomes. Works with the PCP member?s family Supervisor/Manager of Care Management to assess plan implement coordinate monitor and evaluate services and outcomes to maximize the health of the Member.
• In conjunction with the PCP member member?s family and other pertinent members of the Interdisciplinary Care Team (IDT) CM completes a comprehensive assessment and develops a Person Centered Service Care Plan utilizing clinical expertise to evaluate the member?s need for alternative services. Assesses short-term and long-term needs and establishes case management objectives
• Manages 75 to 100 active cases based on case intensity and acuity
• Responsible for Utilization Management and uses prescribed criteria to provide timely appropriate and medically necessary service authorizations
• Interacts continuously with member family physician(s) IDT members and other providers utilizing clinical knowledge and expertise to determine medical history and current status. Assesses the options for care including use of benefits and community resources in order to update the Person Centered Service Care Plan
• Acts as liaison and member advocate between the member/family physician and facilities/agencies
• Maintains accurate records of care management activities in the EMMA system using clinical guidelines
• Coordinates community resources with emphasis on medical behavioral and social services. Applies care management standards and maintains HIPAA standards and confidentiality of protected health information. Reports critical incidents and information regarding quality of care issues
• Ensures compliance with all state and federal regulations and guidelines in day-to-day activities.
• Participates in monthly chart audits
• Performs special projects as assigned.

Qualifications

• 2+ years of experience in a clinical acute care position(s) preferably in home health physicians office or public health Required
• 1+ year of experience in care/case management Required
• Licensed Registered Nurse (RN) Required
• Certified Case Manager (CCM) Preferred

Additional Information

Interested in hearing more about this great opportunity? Please call and e-mail your resume to Courtney Phelps 407-636-7030 ext 207 for immediate consideration.