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Registered Nurse - Case Manager (NH Great Lakes, IL) (2986) - (US-IL-Great Lakes - 60088)
Minimum Education: None
Jobcode: 60015814
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Click Here to Apply OnlineSTG International is an energetic team of vibrant people who strive to make a powerful impact on the world. STG International, Inc is dedicated to providing high-quality professional services to the government and private sector clients.
STG International, Inc is currently recruiting for (2) RN Case Managers to support the Utilization Management Department at the Naval Health Clinic located in Great Lakes, IL.
Duties/Responsibilities:
- Develop and implement local strategies using inpatient, outpatient, onsite and telephonic CM/DM; develop and implement policies and protocols for home health assessments and outcome measures.
- Case Management may require at least one site visit within 30 days of beginning case management services to assess the family situation and facilitate development of the plan.
- Case Management may require at least weekly telephone or direct contact with the family in order to continually monitor and update the treatment plan.
- Maintain communication between service providers individually and during multidisplinary care.
- Visit the PCM offices. For the long term, chronically ill or disable beneficiaries, it is important to establish a good rapport with the PCM and understand the treatment goals that the PCM has established for the patient.
- Develop and implement tools to support case management, such as those used for patient identification and patient assessment, clinical practice guidelines, algorithms, CM/DM software, databases for community resources, etc.
- Integrate CM/DM, utilization management (UM) and nursing case management with social work case management. Prepare routine reports and conduct analyses.
- Establish and maintain liaison with appropriate community agencies and organizations, the TRICARE Regional Office and the health services and support contractor.
- Maintain adherence to JCAHO, URAC, CMSA and other regulatory requirements. Apply medical care criteria (e.g., InterQual).
- Ensure accurate collection and input of patient care data and ensure basic CM/DM budgetary management.
- Oversee MTF CM/DM resources and make recommendations to the command as to how those resources can best be utilized. Immediately notify supervisor of potentially high dollar cases.
- Collaborate with the multidisciplinary team members to set patient-specific goals. Develop treatment plans including preventive, therapeutic, rehabilitative, psychosocial, and clinical interventions to ensure continuity of care toward the goal of optimal wellness. Progress toward established goals will be evaluated by the Case Manager per established protocol (Specifics will be outlined in Standard Operating Procedure provided by Supervisor). Modifications and updates to the treatment plan will be made as necessary for optimal managed care services. For patients who do not require ongoing case management services, information concerning resources for needed services within the community will be made available. The goal is to coordinate services and resources, so as to improve provider access, and reduce administrative tasks for TRICARE beneficiaries, and increase beneficiary satisfaction.
- Establish and implement mechanisms to ensure proper implementation of patient treatment plan and follow-up post discharge in ambulatory and community health care settings.
- Provide nursing advice and consultation in person and via telephone to patients/family members/ significant others.
- Ensure appropriate health care instruction to patient and/or caregivers based on identified learning needs.
- Alert physicians to significant changes or abnormalities in patients and provide information concerning their relevant condition, medical history and specialized treatment plan or protocol.
- Facilitate multidisciplinary discharge planning and other professional staff meetings as indicated for complex patient cases and develop a database and knowledge of local community resources. Once a case is being managed by a case manager, the case manager will complete the discharge plan. The discharge planning process will begin when a length of stay has been assigned. The case manager will assess the patients need for a medically appropriate and timely discharge. Discharge planning will allow the case manger to identify the patients needs for transition from the acute setting to an alternative setting or home. Coordination of post-discharge services is done with the PCM, patient, family, discharge planning staff in the facility, MCSC case manager/discharge planner, and other healthcare providers. Coordination with above will ensure that the home treatment, equipment, and services are ready and available when the patient is discharged. The discharge planning will a
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