Overview
The Registered Nurse provides nursing care to individuals and groups which require specialized knowledge, judgment, and skill derived from the principles of biological, physical, behavioral, social, spiritual/cultural, and nursing sciences. The Registered Nurse functions within the full scope of nursing practice as noted by the Board of Nursing of their designated state for which they are practicing in addition to compliance with any of the hospitals accrediting bodies.
- Full-Time
- Level: Mid
- Travel: No
Success Profile
Who is the ideal Promedica employee? We're looking for people to join our team who are motivated by making an impact and doing meaningful work.
- Responsible10
- Critical thinker9
- Compassionate9
- Communicator9
- Adaptable9
- Multi-tasker8
Additional success profiles:
- Detail oriented,
- Flexible,
- Helpful,
- Patient,
- Responsible,
- Sincere,
- Understanding
Benefits
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Professional
Growth
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Retirement &
Savings Plan
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Innovative
Training Programs
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Tuition Assistance
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Career Stability
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Comprehensive Health
Coverage
At Paramount Health Care, we offer insurance to both large and small groups and also cater to Medicare (Paramount Elite) subscribers in northwest Ohio and southeast Michigan. Our Medicaid product (Paramount Advantage) services those living in the state of Ohio. We maintain an accreditation by the NCQA – the National Committee for Quality Assurance – for our Ohio HMO, Elite and Advantage products. We’re also part of ProMedica, which is ranked the second most integrated health system in the U.S. and No. 1 in the Midwest. For more information about Paramount, please visit our website http://www.paramounthealthcare.com.
ACCOUNTABILITY OBJECTIVE:
Assesses, plans, implements, coordinates, monitors and evaluates the ongoing care of a specific caseload through the Continuum of Care; collaborates with members of the health care team, members and their families to ensure effective, efficient and appropriate care during the entire episode of illness and for post-discharge services. Monitors utilization and evaluates outcomes.
NATURE & SCOPE:</strong>
This position reports directly to the Team Leader. No positions report to this position.
PRINCIPAL ACCOUNTABILITIES:
1. Assess identified “Commercial” members to determine case management needs by trigger diagnoses, disease management needs, high dollar cost, complex medical conditions, readmissions or excessive length of stay. Conduct appropriate assessment based on member needs which includes member, caregiver and provider input. Assess the member's functional status, decision-making ability, and psycho-social needs. Enter identified members into Case Management with provider and member consultation.
2. Planning: Plan an individualized care plan developed in conjunction with the member, provider, health care team and other persons involved in the member's care. The plan should address the member’s health care needs identified in the assessment process. Community resources, psycho-social needs and end of life care are included in the plan of care.
3. Implementation and Coordination: Coordinate current treatment plans with the PCP and maximize benefits through in-Plan provider utilization. Utilize cost benefit analysis. Ensure communication of goals with all health care team members. Coordinate psychological care with in-Plan providers and with Behavioral Health Case Management coordinators.
4. Monitoring and Evaluation: Review the member's progress and conduct periodic reassessment of the care plan based on changing member needs. Evaluate, initiate and coordinate case management members' potential discharge planning and follow-up needs. Evaluate and manage resources and optimize reimbursement to ensure that members receive the most appropriate medical care in the most cost-effective setting.
5. Communication: Provide members and families with ongoing, current information and support to enhance satisfaction throughout the continuum of care. Facilitate communication among members of the health care team. Ensure privacy and confidentiality under current federal regulations. Adherence to ethical, legal and accreditation/regulatory standards.
6. Documentation: Documentation follows current Paramount procedures. Has good knowledge of the member’s coverage, exclusions and insurance guidelines for appropriate system documentation. Demonstrates good skills in the required paper and electronic systems.
7. General: Act as a member advocate, maintain and ensure member privacy and confidentiality, adhere to ethical, legal and accreditation/regulatory standards for all Case Management activities/interventions. While most case management interaction is telephonic through out the case management process as defined above, multidisciplinary face to face meetings with members and providers may be beneficial and necessary to effectively coordinate the member’s treatment plan of care. Must have the ability to travel and make face to face visits with members.
8. Outcomes: Individual case managers will be audited to determine if Interventions are goal oriented. In addition, outcomes will be measured including member satisfaction, clinical, financial and quality of life. Productivity measures must be met and compliance will be reflected on the annual performance evaluation.
9 Perform other duties as directed.
• Current Ohio and Michigan Registered Nurse license required or current Ohio and Michigan license for LSW, LISW, PhD and/or other equivalent and appropriate licensure.
• Valid drivers license with proof of auto insurance.
• Certification in Case Management strongly preferred. If not certified, willingness to obtain certification when eligible and appropriate as deemed by manager.
• Minimum 1 year experience as a Case Management Coordinator or as a Utilization Management Coordinator. Excellent communication (oral and written) and organizational skills required. Demonstrated ability to plan, coordinate and organize multiple priorities.
• Demonstrated PC skills, including word processing/spreadsheet/data base and graphics applications strongly preferred. Experience with electronic health record documentation.
• Ability to move between company work stations and departments; ability to communicate on telephones and operate general office equipment, including computers.
