RN Case Management Coordinator

MERCY HEALTH CORPORATION • Janesville, WI • 1d ago

JOB REQUIREMENTS: ESSENTIAL DUTIES AND RESPONSIBILITIES Will spend no
less than seventy-five percent of time providing direct case management
activities on the phone, face to face, e-mail or other interactive
methods Collects and assesses in depth information about a person\'s
situation and functions to identify individual needs in order to develop
a comprehensive individualized care management plan that will address
those needs, meet goals and improve health outcomes Determines specific
objectives, goals and actions designed to meet the clients\' needs as
identified through the assessment process; determines benefits/coverage
of medical necessity based on MercyCare\'s medical certificate of
coverage Executes specific case management activities and or
interventions that will lead to accomplishing the goals set forth in the
case management plan. Organizes, integrates and modifies the resources
necessary to accomplish the goals set forth in the case management plan.
Monitors the ongoing process by gathering sufficient information from
all relevant sources about the case management plan and its activities
and determine the plans effectiveness. Evaluates case managements
effectiveness in reaching desired outcomes and goal and makes
modifications or changes in the case management plan based on the
evaluation. Participates as educator and resource person for provider
offices and hospital staff as it pertains to the health plan case
management policy and procedures. Will spend no more than Twenty-five
percent of time coordinating and monitoring non direct case management
activities and administrative activities. Demonstrates knowledge of NCQA
Complex Case Management requirements and evidence-based guidelines and
where tolocate the most effective guideline. Ability to assist with
performing of case/barrier analysis, baseline study analysis and create
Quality -Improvement studies and sound study design and interventions
Assists in the gathering and analysis of data Ensures that all
activities are internal and external customer focused, well planned,
organized and controlled to assure the cost effectiveness of all
programs. Assists in the staff support activities of the UM/QI
Committees and other special projects or tasks as assigned by the
supervisor. Assists with developing and updating policy and procedures
for the Quality Health Management Department. Meets CMS standards of
documentation and NCQA standards of documentation. Able to obtain
written consent from members for program participation. Facilitates
meetings and skillfully interacts professionally but in a persuasive
manner with physicians and other health care providers. Achieves
consensus on Individualized Care Plans. EDUCATION AND EXPERIENCE
Graduate of an accredited nursing program. ADN... For full info follow
application link. EOE&AA/M/F/Vet/Disabled. Mercy is an equal employment
opportunity employer functioning under Affirmative Action Plans.
*** APPLICATION INSTRUCTIONS: Apply Online:
ipc.us/t/B552CFCDA238452B

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