RN Case Manager - Neurological Specialties - (Job Number: 274671) at Swedish Health Services
Portland, OR
About the Job
Providence is calling a Case Manager - Neurological Specialties West (1.0 FTE, Days) to Oregon Clinical Programs in Portland, OR.
We are looking for a Care Manager - Neurological Specialties West who will be Care Management is designed to support the patient and practitioner in medical management through the continuum of care. Key services include screening and assessment for medical, psycho-social, and economic needs, transitional planning; assuring appropriate access, level of care and continuity of care; care coordination; education; community referrals and ongoing monitoring for plan effectiveness and continued need of services.
In this position, you will:
- Screening:
- Identify and screen for risk, psychosocial needs and utilization patterns.
- Apply screening criteria and guidelines that validate/support services requested.
- Promote and utilize clinic policies, procedures, tools and reports.
- Assessment/Planning:
- Assessment of patient in relationship to disability, medical diagnoses, psychosocial status, support systems, resources and benefits.
- Identify patients who need skilled care services and medical equipment/supplies.
- When indicated, obtain and interpret insurance information to patients and families and practitioners. Advocate and refer to health plans for benefit exceptions.
- Demonstrate respect for the patient by honoring their right of self-determination.
- Actively support measures that promote effective use of resources. Incorporate this into daily work by identifying most appropriate and cost efficient types of services.
- Identifies other resources to address financial shortfalls as needed.
- Coordination and Communication:
- Link patient to appropriate PHS or community resources.
- Coordinate, with PHS organizations and community resources when appropriate, multiple details of transitional/care management plan.
- Identify opportunities regarding alternative delivery and funding sources for patient.
- Education:
- Provide appropriate education for the patient and family regarding community services and support systems.
- Reinforce medical regimen, clinical paths and practice guidelines.
- Documentation:
- Record all information and maintain all "paperwork" required. Collect, interpret and provides statistical data as required.
- Document medical necessity and plan for transition, care coordination and continuity.
- Utilize current procedures, document care management goals, interventions, progress and outcomes.
- Maintain confidentiality of patient/member records per PHS policy.
- Consistently document services according to coding and billing practice guidelines.
- Monitoring:
- Monitors effectiveness of plan and adjusts interventions appropriately.
- Track ongoing care coordination and assistance needs, access and utilization patterns.
- Actively participates in investment analysis of the Care Management Program within Physician Enterprise.
- Teamwork/Collaboration:
- Consults with physician and interprets access, continuity, coordination and home care needs of patient.
- Informs providers and payors of patient status and service needs; consults with them on modification of care plan and financial arrangements.
- Promotes teamwork and collaboration with other team members.
- Participates, when asked, in clinic staff meetings and committees and community-based initiatives.
- May be required to provide care management services in different settings.
- Continual Improvement:
- Actively supports and may facilitate continuous quality improvement activities.
- Maintains, updates and actively improves care management skills, including identifying high risk individuals, care coordination, transition planning and implementation, documentation and evaluation of effectiveness, chronic disease interventions and issues, teamwork, physician communication, process improvement, knowledge of community resources.