Chronic Condition Case Manager RN Role

Our role for a Chronic Condition Manager allows you to leverage your clinical nursing expertise to develop a healthcare plan that meets the needs of patients while continuing to grow professionally in healthcare knowledge and perspective.

The ideal candidate will be responsible for utilizing medical knowledge to assess patient needs and provide individualized coaching for developing a plan that meets healthcare needs and patient goals of self-management of chronic medical conditions.

As a Chronic Condition Manager, you will be accountable for telephonic assessment, planning, implementation, coordination, education, monitoring, evaluation, and outcomes measurement.

You will serve as a patient advocate, promoting safety and maintaining privacy and confidentiality in accordance with policies and procedures.

Duties and Responsibilities

• Identify problems while assessing the patient's medical and psychosocial status, including environmental and cultural influences.
• Determine economically responsible options available to meet the patient's medical and care needs.
• Understand policy/benefit plans and systems.
• Collaborate with physicians, providers, and patients/families and payers to facilitate quality, timely, and efficient medical care across the healthcare continuum.
• Implement disease management plans by coordinating resources, including community resources, healthcare providers, and significant others.
• Evaluate the disease management plan and its effects on the patient and make modifications as necessary.
• Improve health outcomes and quality of life with reduced complications and costs for persons with chronic health conditions.
• Promote patient self-management of chronic health conditions through individual assessment, education, and use of motivational interviewing principles/techniques.
• Utilize clinical practice guidelines and promote best care for people with chronic medical conditions.
• Communicate effectively with TPAs, insurers, physicians, patients/families, and other healthcare providers, including ability to negotiate with assertiveness.
• Effectively communicate the disease case manager's impressions of methods available to provide for the medical needs of the individual patient or the need to refer to a higher level for review of questionable plans of treatment.
• Provide written documentation concerning the information obtained regarding the patient's status, treatment plan, and disease management interventions.
• Interface with UM, CM, and peer review, and other programs, as indicated on active cases.
• Communicate knowledge of policy and procedure, standards of practice, and their revision; Participate in annual HIPAA, ethics, cultural, and URAC standards training.
• Provide good customer relations by promoting goodwill and understanding between claimants, payers, providers, and professional staff at all times.
• Act as an advocate, maintain privacy, confidentiality, promote safety, and comply with policies and procedures, URAC standards, and other regulatory standards.
• Responsible for and retain accountability for the disease management plan and process when using assistance of support staff; provide input on the support staff to their supervisor.
• Special projects assigned by supervisor.

Qualifications

• Registered nurse with current unrestricted license to practice in the state or in a state that has licensure reciprocation with the state of the office location that employee is working in. Registered dietitian practices under current unrestricted registration as dictated by the Commission on Dietetic Registration.
• Successful completion of disease management orientation program.
• Minimum of 2 years full-time equivalent of direct clinical care to the consumer.
• Excellent communication skills.
• Basic typing/computer knowledge with minimum keyboarding speed of 35 WPM.
• Previous disease management or case management experience helpful but not required.
• Obtaining certification in CCM or CHC encouraged.

Physical Requirements

• No significant physical exertion required.

*Hines welcomes diversity and as an equal opportunity employer, all qualified applicants will be considered regardless of race, religion, color, national origin, sex, age, sexual orientation, gender identity, disability, or protected veteran status.*