RN Case Manager

HealthPartners is hiring an RN Case Manager. This position exists to provide support to patients, their families, and physicians in addressing medical and social concerns; educate and empower patients and families to make informed personal health care decisions; and facilitate communication between patient, physician, health plan and community.

ACCOUNTABILITIES: 

• Member Focus

  • Ensures all activities are member-focused and individualized, resulting in personalized attention to each patient’s unique needs.

  • Identifies interventions and resources to assist member reaching personal health related goals.

  • Identifies patterns and episodes of care that are predictive of future needs and services.

• Integration

  • Integrates clinical and psychosocial information for case identification and individual patient assessment to develop action-oriented and time-specific planning and implementation of appropriate interventions.

  • Facilitates integration of patient care by encouragement of effective communications between patients, families, providers, health plan and care system programs, and community-based services. 

  • Adheres to department policy and procedure in daily activities. 

  • Coordinates service coverage with appropriate funding sources when indicated.

  • Works with Supervisor, Case Management, Government Programs department and Member Services department to ensure compliance with Medicare requirements and regulations.

• Communication

  • Effectively communicates with patients and their families to provide them with a better understanding of their health, health care benefits, and health care system.

  • Effectively and routinely communicates with patients, families, physicians and health care team members to facilitate successful collaboration resulting in high levels of member/patient/family/provider satisfaction.

  • Provides educational information and materials to members to support preference sensitive decisions.

  • Provides regular reporting of member outcomes to Case Management leadership according to defined process.

  • Identifies and promptly reports potentially adverse situations to leadership as outlined in department policy and procedure.

  • Identifies and promptly reports high cost cases for reinsurance.

  • Maintains current and accurate documentation and case management files in accordance with Case Management policy and procedure.

  • Maintains confidentiality of information in accordance with department and corporate policies.

• Relationships and Team Building

  • Establishes and maintains good working relationships within the Case Management department, with other HealthPartners departments, and with other health team participants. 

  • Supports other team members in achieving patient centered goals.

  • Assists supervisor in maintaining a cohesive Case Management team by contributing to a collaborative, respectful, and diverse environment.

  • Participates in and contributes to appropriate departmental and/or organizational meetings.

• Technology

  • Maintains knowledge of and effectively uses automated applications and systems.

  • Identifies deficits in technological literacy and seeks appropriate training under guidance of supervisor.

  • Maintains maximum individual productivity through proficient use of automated systems.

• Personal Development

  • Participates in ongoing independent study and education-related professional activities to maintain and increase knowledge in the areas of Case Management, patient care services, and benefit packages for development of effective case management skills.

  • Demonstrates responsiveness to and appreciation of constructive feedback and recommendations for personal growth and development.

  • Maintains current, active Minnesota nursing licensure.

  • May maintain current, active nursing licensure in other states as assigned.

• Other Duties

  • Willingly participates in various committees, task forces, projects, and quality improvement teams, as needed and assigned.

  • Performs other duties as assigned.

CURRENT DIMENSION: 

• Directly reports to Supervisor, Case Management.

• Directly manages caseload with anticipation of up to 85 members with complex needs.

• Interacts with medical, administrative, and front line staff within and outside the organization in order to collaborate on members care.

REQUIRED QUALIFICATIONS: 

• Registered Nurse with current unrestricted license in the State of Minnesota, BSN preferred. License free of history of restrictions and/or sanctions in the past 10 years in all states with current or past licensure.

• Minimum of 3 years clinical practice experience in an acute care setting; minimum of 3 years relevant utilization review, discharge planning, or case management experience; and current clinical knowledge.

• Demonstrated effective, independent nursing judgment and skills.

• Demonstrated skill and experience in effectively collaborating with care team members, using a high level of expertise in written, oral and interpersonal communication.

• Demonstrated working knowledge of quality improvement, utilization management, benefit plans, fiscal management, and various payment methodologies preferred. Understanding of healthcare and/or HMO industry.

• Demonstrated skill in effective use and management of automated medical management systems.

• Demonstrated flexibility, organization, and appropriate decision-making under challenging situations.

• Basic computer skills 

CHALLENGES:

• Maintaining member focus in a rapidly evolving environment.

• Influencing team members and colleagues to work collaboratively in achieving the goals and objectives of the Case Management Program.

• Contributing a positive team building approach as a member of the Case Management team, and a global member of the Case Management Department.

DECISION-MAKING:

• Makes independent decisions within the scope of this position’s accountabilities and determines the need for and the timing of consultation with Case Management leadership and/or Medical Director.

• Uses professional clinical judgment, organizational knowledge, industry knowledge, and common sense in determining appropriate alternatives for members/patients/families, consulting with leadership and/or Medical Director, when indicated. 

• Makes recommendations to leadership regarding policy development needs and/or changes.