RN Case Management Coordinator

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 required upon hire, BSN preferred.

Minimum of 2 years experience required.

CERTIFICATION AND LICENSURE

Licensed as an RN in state of practice-Wisconsin and Illinois

Certified Case Manager (CCM) or obtaining case manager designation within 2 years of hire.

SKILLS AND ABILITIES

Demonstrates knowledge of case management activities and core components

Provide case management to members who meet specific criteria for complex and specific disease management

Demonstrated ability to work within a team environment

COMPUTER SKILLS

To perform this job successfully, an individual will be using the computer for documentation a majority of the time and should be able to type proficiently on a keyboard and have proficient knowledge of Microsoft Office Specifically, Microsoft 365, Word, Access and Excel. An individual should be able to view and understand areas in MHS Power and EPIC EMR.

OTHER QUALIFICATIONS

The successful CM Coordinator must be able to function at a highly independent and autonomous level. The CM Coordinator insures that all activities are individually focused for the customer to improve health outcome. All activities are well planned, organized and controlled to assure the cost effectiveness of the various programs. The incumbent identifies key case management problems and quality issues, trends and variances and determines what information is necessary to develop solutions. Acts as an external and internal spokesperson for the department and support system wide efforts and resolutions.

May include color blind test (per department guidelines)

SPECIAL PHYSICAL DEMANDS

The Special Physical Demands are considered Essential Job Function of the position with or without accommodations.

While performing the duties of this job, the employee is frequently required to sit. Specific vision abilities required by this job include close vision, peripheral vision and ability to adjust focus.

LEVEL OF SUPERVISION

This job has no supervisory responsibilities of other employees. The Complex Case Management Coordinator is responsible for the management and coordination of services that are part of the care plan for the individual members that meet criteria for participation. Also responsible for coordinating and facilitating Interdisciplinary Care Team meetings for individual members and assuring that the team members have the Individualized Care Plan and that it is being implemented for the member.

SUPERVISES

This role has no supervisory responsibilities.

PAY RANGE:

Mercyhealth is an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identify, national origin, disability, or protected veteran status.

Mercyhealth offers competitive pay and a comprehensive benefits package including:

• Medical, Dental, Vision

• Life & Disability Insurance

• FSA/HSA Options

• Generous, accruing paid time off

• Paid Parental and caregiver leave

• Career advancement and educational opportunities

• Tuition and certification reimbursement

• Certification Reimbursement

• Well-being Programs

• Employee Discounts

• On-Demand Pay

• Financial Education

• Annual recognition/awards events

• Partner appreciation days

• Family entertainment/attractions discount

• Community service/improvement opportunities

Click here for more details regarding Mercyhealth Careers Benefit Information.

At Mercyhealth, we don't simply hire people, we empower employee-partners who are passionate about making lives better. As an integrated health system, we deliver exceptional, coordinated across seven hospitals, 85 primary and specialty clinics, and a team of over 7,500 professionals serving northern Illinois and southern Wisconsin.

Mercyhealth has been nationally recognized for our commitment to our people and culture, including:

• #1 in the nation on AARP's Best Employers for Workers Over 50

• One of Working Mother magazine's 100 Best Companies for Working Mothers

• A Top 50 Company and Top 10 Nonprofit for Executive Women