What are the responsibilities and job description for the Chronic Condition Case Manager RN position at Hines & Associates Inc?
Chronic Condition Manager Role
Our Chronic Condition Manager role enables you to utilize your clinical nursing experience to develop a plan for meeting healthcare needs of patients, while continuing to professionally grow in healthcare knowledge and perspective. Be the patient advocate you desire to be.
In this key role, the ideal candidate will be responsible for utilizing medical knowledge to assess patients and provide individualized coaching for the purpose of developing a plan for meeting the healthcare needs and patients' goals of self-management of chronic medical conditions. The Chronic Condition Manager is accountable for telephonic assessment, planning, implementation, coordination, education, monitoring, evaluation, and outcomes measurement. The Chronic Condition Manager is a patient advocate, promotes safety, and maintains privacy and confidentiality in accordance with policies and procedures.
Duties and Responsibilities:
- Identify problems while assessing patients' medical and psychosocial status, including environmental and cultural influences.
- Determine economically responsible options available to meet patients' 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 disease management plans and their effects on patients 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 assessments, education, and use of motivational interviewing principles/techniques.
- Utilize clinical practice guidelines and promote best care for people with chronic medical conditions.
- Demonstrate ability to communicate effectively with TPAs, insurers, physicians, patients/families, and other healthcare providers, including ability to negotiate with assertiveness.
- Effectively communicate disease case managers' impressions of methods available to provide for the medical needs of individual patients or the need to refer to a higher level for review of questionable plans of treatment.
- Provide written documentation concerning information obtained regarding patients' status, treatment plans, 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 be compliant with policies and procedures, URAC standards, and other regulatory standards.
- Responsible for and retain accountability for disease management plans and processes when using assistance of support staff; provide input on support staff to their supervisor.
- Special projects as assigned by supervisor.
