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The Case Manager is responsible for applying the six essential activities of case management, including assessment, planning, implementation, coordination, monitoring, and evaluation, focusing on quality improvement functions. Key duties involve assessing patient needs, developing and evaluating care plans, ensuring regulatory compliance, and acting as a patient advocate.
Requirements summary
Candidates must be a Registered Nurse (RN) with an active, unrestricted license in an NLC state and possess three years of clinical RN experience in a med/surg or ambulatory care setting. Case Management Certification (CCM) is required, or it must be obtained within three years of employment.
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Accepting candidates with NCL from Florida, North Carolina & Arizona Overview The Case Manager will be responsible for applying the six essential activities of case management which include assessment, planning, implementation, coordination, monitoring and evaluation with the core components through the administration of quality improvement functions (process, relationships, health care management, community resources and support, service delivery and psychosocial intervention).
Qualifications Registered Nurse (RN) with active, current, unrestricted license in a Nurse Licensure Compact (NLC) state required.
Bachelor’s degree preferred.
Case Management Certification (CCM) required.
Candidates without CCM certification are required to obtain it within three (3) years of commencing employment.
Three (3) years of clinical RN experience in a med/surg or ambulatory care setting required.
Clinical experience in at least one of the following areas preferred: Behavior Health, Transplant, Neo-Natal or Oncology.
Previous experience in managed care a plus.
Clinical knowledge of the health or social work needs for the population served.
Ability to identify barriers to a successful care management path.
Ability to interact effectively with physicians and other members of the health care team.
Excellent problem-solving abilities, coupled with solid time management skills.
Excellent written, verbal and interpersonal communication skills.
Transferable knowledge, skill and ability to complete job duties independently and proficiently.
Flexibility in work schedules and assignments.
Proven examples of displaying Nova’s Core 4: Act with Passion, Work Together, Be Accountable, Build Trust.
Essential Accountabilities Assess the patient’s broad spectrum of immediate and long-term needs through evaluation of the patient’s social and medical history.
Develop a plan of care based upon the patient and providers of care clinical assessments, considering physical and psychosocial needs, the benefit plan and cost benefit analysis factors which impact the patient’s optimal recovery.
Benefits
Full range of benefits
Continuously evaluate the plan of care within the scope of case management practice based on the changing needs of the patient and monitor the quality of care and effectiveness of care being provided for all involved members of the inter disciplinary team.
Ensure compliance with regulatory and privacy standards, prompt payment/reimbursement and appeal process as indicated; coordinate the decision and documentation process; maintain a current and accurate database.
Establish professional working relationships with all members of the interdisciplinary team and communicate case objectives to the appropriate involved parties.
Act as a patient advocate understanding and identifying potential for complications, understanding methods for assessing the current and future physical and psychosocial characteristics of illnesses.
Read, understand and apply principals of the American with Disabilities Act and understand federal legislation affecting individuals with disabilities.
Be knowledgeable of assistive and adaptive equipment.
Establish available support systems and be versed in methods of researching and interviewing community resources to assist the patient in achieving maximum psychological, social and physical recovery.
Effectively communicate to the patient the available services and resources applicable to the patient’s immediate and future needs.
Assist the patient in obtaining these services.
Identify cases that would benefit from alternative care through assessment and evaluation of the patient’s needs, as well as available resources.
Work closely with the payor, providers and all involved team members in evaluating the quality and cost effectiveness of services.
Negotiate cost discounts when appropriate.
Identify cases that would benefit from alternative levels of care and resources (i.e. rehabilitation facilities and home health care providers).
Implement alternatives to existing care, considering quality of care and the patient’s current and ongoing needs.
Understand case management concepts such as roles, philosophies, principles, liability and confidentiality issues.
Apply these concepts in developing appropriate plan of care and goals based on the needs of the patient.
Be knowledgeable in applying problem solving techniques to the case management process.
Analyze and evaluate outcomes and implement alternatives when appropriate.
Document the patient’s plan of care in a timely manner.
Maintain professional status within the community through membership in professional organizations and/or participation in continuing education.
Participate in Nova’s training and education committees as assigned.
Provide input into support staff orientation and training as it relates to the Case Manager’s role.
Provide support, guidance, and direction to support staff as indicated.
Perform all assignments in a professional manner.
Be knowledgeable of the scope of practice of their multi-state licensure and practice accordingly.
Immigration or work visa sponsorship will not be provided for this position Hiring Compensation Range: $35.50 - $38.00 hourly Compensation may vary based on factors including but not limited to skills, education, location and experience.
In addition to base compensation, associates may be eligible for a scorecard incentive, full range of benefits and generous paid time off.
The base salary range is subject to change and may be modified in the future.
As an Equal Opportunity / Affirmative Action Employer, Independent Health and its affiliates will not discriminate in its employment practices due to an applicant’s race, color, creed, religion, sex (including pregnancy, childbirth or related medical conditions), sexual orientation, gender identity or expression, transgender status, age, national origin, marital status, citizenship and immigration status, physical and mental disability, criminal record, genetic information, predisposition or carrier status, status with respect to receiving public assistance, domestic violence victim status, a disabled, special, recently separated, active duty wartime, campaign badge, Armed Forces service medal veteran, or any other characteristics protected under applicable law.
Click here for additional EEO/AAP or Reasonable Accommodation information.
Current Associates must apply internally via the Job Hub app.
The Independent Health Family of Companies, headquartered in Buffalo, NY, serves nearly 400,000 members and provides innovative health care products and benefits designed to engage consumers in their health and well-being.
Established in 1980, our comprehensive portfolio includes Pharmacy Benefit Dimensions, Reliance Rx, Nova Healthcare Administrators, Care for You and the Independent Health Foundation.
Our culture sets us apart.
Our core values drive who we are and the work we do.
As a member of our family, you’re part of something special, in your work and in the community.
We understand and appreciate that everyone has unique experiences, perspectives and identities which is why we pledge to create a safe space where all people and ideas are welcomed.
We are here to continue learning and to generate important dialog.
We are committed to doing what matters most - reaching out, working together, and caring for our community.
A healthy community benefits everyone who lives in it.
You too can be part of making difference in the lives of others, together we achieve so much more.
Please click here to view our Community Reports.
Apply today and join us on the journey to a happier, healthier, and more inclusive community.
We are committed to providing reasonable accommodations for qualified individuals with disabilities and disabled veterans.
An applicant for employment in need of an accommodation to participate in the application and recruitment process should contact Human Resources at: accommodations@independenthealth.com or Human Resources, 511 Farber Lakes Drive, Williamsville, NY 14221.
Please note, we do not accept unsolicited resumes.
We do not accept resumes from headhunters, placement agencies, or other suppliers that have not signed a formal agreement with us.
