NURSE CASE MANAGER

TEAM is looking for a Nurse Case Manager to provide services to keep patients in the best physical condition by working both proactively and reactively. In this role, you will coordinate programs and services between various agencies and individuals; coordinate provider appointments for their patients, work with health plans to ensure swift authorization, and arrange schedules to accommodate procedures; continuously evaluate patient’s progress to ensure the treatment plan is being followed; and develop a continuum of services that runs uninterrupted until the client has made a full recovery. As a Nurse Case Manager, you will be responsible for overseeing and coordinating short-term and long-term medical care for patients and act as a member of the clinical team. At TEAM, we take a holistic approach to understanding client issues.

The position is Monday-Friday, Full Time/In-Office. The Nurse Case Manager’s salary is $75,000 -$90,000/year, commensurate with education and experience.

Excellent benefits package including:

Reimbursement for License Fees, Continuing Education, Paid Continuing Education Days, Tuition Reimbursement, Liability and Malpractice Insurance, Paid Time Off, Holiday Pay, Low Deductible Medical plan and Dental Offerings, Health and Dependent FSA, a Generous Retirement Plan, and additional voluntary benefit options.

Education:

Bachelor of Science in Nursing (BSN) or Registered Nurse (RN) degree from an accredited college or university required.

Experience:

A minimum of three (3) years' experience in medical management, clinical nursing, case or disease management, health benefit plans, health insurance, home care services, or related field is required. Minimum of one year telephone triage or call center background preferred. Bilingual in Spanish/English is a plus.

Essential Job Responsibilities

• Provide telephonic, video, and/or on-site case management and concurrent review for patients with high level of acuity and/or co-morbidities.
• Facilitate access to healthcare providers, benefit and entitled coverage information, health services, and health resources.
• Communicate clear non-prescriptive messages to members regarding planned activities, expected results, and anticipated timeframes of medical procedures and diagnoses.
• Build relationships with members to collaborate and develop plans of action.
• Facilitate communication among members, treating physicians, and insurance carriers, by asking necessary health questions to physicians or clarifying insurance plan provisions.
• Monitor medical necessity, appropriateness and efficiency of care using established guidelines, contacting Clinicians, Supervisors, Physicians, Specialists, Hospitalists, Clinical Directors, and Medical Directors as needed.
• Participate in discussion of delays / barriers / progression of care at care coordination meetings.
• Consistently apply TEAM organizational and department values (Mission / Vision / Initiatives) and continuous quality improvement in daily work.
• Be knowledgeable of client/patient’s available benefits / community programs and resources/ coverage / payer information.
• Facilitate communication between patients, family, provider, social services, and vendors to maintain continuity of care and appropriate use of resources.
• Coordinate transfer of patients to in network facilities when appropriate.
• Remain current with knowledge and skills of case management practices, and application of guidelines, policies and procedures related to nursing.
• Maintain confidentiality of information obtained in performance of duties as well as TEAM policies & procedures.
• Discuss cases not meeting medical necessity criteria and cases with utilization issues with care team members and clinical director as needed.
• Serve as a liaison to other agencies, departments, or community resources as needed to coordinate care in transition planning.
• Identify and refer to supervisor all cases involving potential high cost, sensitive or complex medical/mental health issues for review.
• Record, monitor and report data such as clinical outcomes achieved, potentially avoidable and medically necessary variances, length of stay, reviews completed and outcomes, and discharge dispositions on a daily basis.
• Work with the care team and attending provider to create an actionable plan of care and transition / discharge plan for each patient followed, as needed.
• Demonstrate knowledge regarding transition criteria and level of care and use of appropriate community-based resources.
• Review and assess cases for eligibility, benefits and limits, medical necessity and ongoing appropriate level of care.
• Function independently and as part of a team, working effectively with various departments, internal and external staff, facilities, clients, clients’ families, and providers to facilitate quality and efficient client care.
• Provide services on-site throughout the covered area on an as needed basis, based on assignment / request.
• Provide assessments for clients referred on a mandated/formal basis by employers or unions. Solicit perspectives of the referring party as well as the client.
• Explain benefits coverage and resolve errors with providers and health plans.
• Perform other duties and projects as assigned.

Job Type: Full-time

Pay: $70,000.00 - $85,000.00 per year

Benefits:

• 401(k)
• 401(k) matching
• Dental insurance
• Employee assistance program
• Flexible spending account
• Free parking
• Health insurance
• License reimbursement
• Life insurance
• Paid time off
• Tuition reimbursement
• Vision insurance

Schedule:

• 8 hour shift
• Day shift
• Monday to Friday

License/Certification:

• RN Minnesota License (Required)

Ability to Relocate:

• Minneapolis, MN 55435: Relocate before starting work (Required)

Work Location: In person

Job Type: Full-time

Pay: $75,000.00 - $90,000.00 per year

Work Location: In person