Medix Staffing Solutions

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LVN or RN Case Manager

at Medix Staffing Solutions

Posted: 10/2/2019
Job Status: Full Time
Job Reference #: J3R21Q66Y3QLP39S49Y

Job Description

Job Summary:

  • Care Management is a collaborative practice model including patients, nurses, social workers, physicians other practitioners, caregivers and the community.
  • The care management process encompasses excellent communication, both verbal and written and facilitates care along a continuum through effect resource coordination.
  • The goal of the Care Manager is to advocate for and assist the patient in the achievement of optimal health, access to care and appropriately utilizing resources.
  • The LVN Care Manager utilizes the following processes to meet the patient's individual health care needs: collects data, assists in planning, implementation, coordination, monitoring and evaluation of the plan of care.

Essential Functions:

  • Data Collection: collecting in depth information about a persons' and functional status to identify individual needs to develop a comprehensive plan of care.
  • Care Manager will identify present and possible future needs of the patient and family.
  • Data will include age specific physical, psychological, environmental, financial and health status expectations
  • Planning: assist with identifying specific objectives, goals and actions identified in the collection of data.
  • Care Manager will act as a patient advocate and collaborate with the physician, patient and family, members of the healthcare team to formulate a shared plan of care.
  • Goals and time frame for goals appropriate to the patient will be set.
  • Implementation: executes specific interventions that will assist in accomplishing the goals and timeframes of the shared plan of care.
  • Works effectively with the healthcare team to determine necessary steps to achieve plan of care
  • Problem solving techniques will be applied to the implementation process.
  • Care Manager will utilize knowledge of alternative funding sources, benefit plans, and contractual information to promote appropriate quality, cost effective care for members throughout the healthcare continuum.

Coordination: organizes, coordinates, provides and modifies or obtains appropriate authorizations to accomplish the patients goals and initiates and communicates with the patient and family, physicians, healthcare team members and community.

  • Facilitates continuity of care throughout all access points.
  • Monitoring: obtains sufficient information from all relevant resources in order to determine the effectiveness of the plan of care, and/or services provided.
  • Manages a caseload of high risk, complex needs and/or catastrophic patient

Evaluation:

  • Care Manager at appropriate and repeated intervals, evaluates the patients' progress.
  • If progress is static or regressive, Care Manager will determine the reason and encourage appropriate interventions to obtain optimal outcomes, including communication with healthcare team.
  • Care Manager will modify plan of care as necessary in coordination with the healthcare team, family members and providers.
  • Communication: Care Manager will communicate both verbally and electronically with the patient and healthcare team.
  • Appropriately documents the plan of care, patient progress, outcomes, statistical reporting, logs and files abiding to departmental, legal and regulatory requirements.

Additional Responsibilities:

  • Research and assist in the resolution of patient appeals, grievances and complaints by gathering necessary clinical information and responses as appropriate.
  • Files appeals and grievances within the appropriate timelines set by regulatory compliance.
  • Reports findings (time frame: monthly, quarterly) to (appropriate committee)
  • Performs all other duties as assigned