Acts as an advocate for the patient, assisting them to reach optimal function and health in an appropriate environment that would support their needs. The Case Coordinator functions within the full scope of practice to include the major responsibilities of the position and to extend these responsibilities beyond the episode of care to encompass coordination of care across the continuum. The Case Coordinator applies the processes of assessment, planning, implementation, monitoring, evaluation, and coordination of care to meet the patients’ health care needs across the continuum in collaboration with health team members and community members, to ensure safe, quality, and cost-effective care.
Qualified individuals must have the ability to perform the following duties:
- Conducts assessments of patient/family needs by coordinating input from all health professionals and formulating a plan assuring continuity of care for the rising and high-risk patients.
- Functions as a coordinator and manager of a defined health population across care settings and for multiple health care providers/facilities or health plan counterparts. Works closely with their assigned care partners/facilities to offer individualized assistance with improving and maintaining quality patient care.
- Identifies appropriate providers, facilities, external healthcare organizations throughout the continuum of care and communicates with an interdisciplinary treatment team to develop and maintain positive working relationships.
- Coordinates care across the continuum (inpatient/outpatient/community) to assure appropriate utilization of clinical and community resources.
- Oversees and guides the development of multiple health partnerships to achieve a positive health effect.
- Participates on a team for data collection, health outcomes reporting, clinical audits, and programmatic evaluation related to initiatives. Focuses on outcomes including the successful transition to the previous level of care, reduction in re-admission rates, and targeted lengths of stay.
- In conjunction with the practice team, identifies patients at risk for poor outcomes or experiencing poor coordination of services who would benefit from more intensive follow-up.
- Provides chronic disease and self-management education and support to clinical partners.
The following duties are considered secondary to the primary duties listed above:
- Assist in the coordination of the development of practice parameters with the assigned facilities and Medical Staff of the assigned facilities.
- Identifies professional needs to maintain expertise and keep current with health care trends, both clinical and financial.
- Serves on committees and actively participates in staff/facility meetings and performance improvement activities, using best practice processes.
- Helps in the identification of best methods to transmit a case management plan to all points of care provided in the health care system, and county social service agencies.
- Actively engages in educational activities with partner facilities and staff.
- Other duties as assigned.
MINIMUM REQUIRED QUALIFICATIONS
- An RN is required for this role, current licensure as a Registered Nurse in the state of Maryland. Bachelor’s Degree in nursing (BSN) or a related healthcare degree required.
- Three (3) years of acute care nursing experience
- One (1) year experience in case coordination and planning as well as experience in program implementation and execution.
- Excellent verbal and written communication skills.
- Excellent customer service skills.
- Proven informal leadership skills.
- Ability to work independently, setting priorities to coordinate care plans efficiently.
- Ability to work effectively in a fast-paced team environment.
- Highly organized and detail-oriented with the ability to perform multiple tasks
- Effective behavioral and educational strategies, including, but not limited to: motivational interviewing, teach-back method and self-management support.
- Demonstrated experience successfully working among multi-disciplinary teams.
- Five (5) years of case management experience
- Care management experience in a post-acute care setting
- Care management experience in a managed care setting
- Case Management certification (ACM/CCM) within 3 years
- Bachelor’s degree in Nursing (BSN)
- Knowledge of utilization review or managed care
- Long Term Care / Post-Acute Nursing facility experience
- Two (2) years as a health care professional
Please send your resume to Phyllis Wojtusik at email@example.com, for immediate consideration