Case Manager-Hometown Health

This position collaborates with their interdisciplinary team members using a collaborative nursing process that assesses, plans, implements, coordinates, monitors, and evaluates options and services based on available community resources and health insurance benefits. Coordinates services provided for members with chronic conditions, acute conditions, and behavioral health needs across the lifespan to improve the quality of care and satisfaction. Identifies social determinants of health and clinical symptomology needing intervention and works within the framework of the IDT to build a longitudinal plan of care assisting members with their health care goals. Has the current knowledge of applicable regulations and laws pertaining to Hometown Health plans.

This position shall coordinate all components of the Care Coordination services to provide for the individual patients' health care needs though the continuum of care. This includes Care Coordination which involves deliberately organizing patient care activities and sharing information among all the participants concerned with the members/ patients care to achieve safer, and more effective care. This means the members' needs and preferences are known ahead of time and communicated at the right time to the right people, and that this information is used to provide safe, appropriate, and effective care.

Knowledge, Skills & Abilities:

* Strong interpersonal communication skills both written and verbal.

* Collaborate with member, family, providers, and team members to develop a patient centered, culturally sensitive plan of care supporting patient with self-management goals, remains productive and offers help and support to team members,

* Coordinates alternative community resources to include Social Determinants of Health needs, home health care, durable medical equipment, meals on wheels, hospice, etc. to promote and assist in keeping the member safe in the environment of their choice and in alignment with the member wishes.

* Facilitate, problem solve with patients, families, providers, and other health care professionals to effectively resolve patient care issues. Helps with transitions of care and organizes medical information Transitions member to other team members as needed depending on environment and need.

* Understands how to navigate Care Coordination process of Assessment, Planning, Goal Setting, Intervention, and Evaluation with the ability to utilize these components to provide for the individual health care needs and promote positive outcomes (quality),

* Initiates, updates, and revises: Assessments, Patient Outreach Encounter documentation and Interdisciplinary Care Plan within the EMR.

* Knowledge of continuous quality improvement process.

* Knowledge of applicable regulatory requirements and community resources.

* Respects the beliefs and values of Hometown Health members while advocating for the client's right to self-determination and make informed choices.

* Knowledge of group and individual health insurance plans, Medicare Advantage Plans, Centers for Medicare, and Medicaid Services (CMS) NCQA accreditation requirements.

May be responsible for other duties as assigned.

This position may be member/patient facing, virtual, telephonic or in person visits.

The foregoing description is not intended and should not be construed to be an exhaustive list of all responsibilities, skills and efforts or work conditions associated with the job. It is intended to be an accurate reflection of the general nature and level of the job.

Name

Description

Education:

Must have working-level knowledge of the English language, including reading, writing, and speaking English. Bachelor of Science in Nursing Degree preferred.

Experience:

Minimum one year of clinical experience working in an in-patient or outpatient setting required, two years preferred. Minimum of one year of experience in managed care or case management, recommended.

License(s):

Current and unrestricted State of Nevada Registered Nurse license and licensure from State in which they have residency required.

Certification(s):

Utilization or Case Management Certification desirable.

Computer / Typing:

Must be proficient with Microsoft Office Suite, including Outlook, PowerPoint, Excel, and Word and have the ability to use the computer to complete online learning requirements for job-specific competencies, access online forms and policies, complete online benefits enrollment, etc.