RN Complex Case Manager Job

Bloomington, MN, 55420
Apr 06, 2012
Apr 26, 2012
Employment Status
Full Time
RN Complex Case Manager

Job ID:: 23344
Department:: Health Plan Case Mgmt
City:: Bloomington, MN
Location:: HP - Bloomington 8170 Office Bldg
Position Type:: Full-Time
Anticipated Work Schedule:: This is a four day per week .8 position. Day off TBD.
Hrs/Pay Period:: 64

Job Description::

The culture at HealthPartners is one of ownership, pride, service, and most importantly, partnership. That spirit of partnership among employees, and with patients and the community is just one of the many reasons we were recently named one of the Twin Cities best places to work by the Minneapolis/St. Paul Business Journal. Join us for a career that offers respect, support and encouragement. You’ll stay for the power of partnership.

We are currently seeking a RN Case Manager to provide support to the complex patient populations, their families, and physicians in addressing medical and social concerns. This person will educate and empower patients and families to make informed personal health care decisions and will facilitate communication between patient, physician, health plan and community.

Additional responsibilities include:
 Ensures all activities are member-focused and individualized, resulting in personalized attention to each patient’s unique needs.
 Identifies interventions and resources to assist member reaching personal health related goals.
 Identifies patterns and episodes of care that are predictive of future needs and services.
 Integrates clinical and psychosocial information for case identification and individual patient assessment to develop action-oriented and time-specific planning and implementation of appropriate interventions.
 Adheres to department policy and procedure in daily activities.
 Coordinates service coverage with appropriate funding sources when indicated.
 Works with Supervisor, Case Management, Government Programs department and Member Services department to ensure compliance with Medicare requirements and regulations.
• Communication
 Effectively communicates with patients and their families to provide them with a better understanding of their health, health care benefits, and health care system.
 Effectively and routinely communicates with patients, families, physicians and health care team members to facilitate successful collaboration resulting in high levels of member/patient/family/provider satisfaction.
 Provides educational information and materials to members to support preference sensitive decisions.
 Provides regular reporting of member outcomes to Case Management leadership according to defined process.
 Identifies and promptly reports potentially adverse situations to leadership as outlined in department policy and procedure.
 Identifies and promptly reports high cost cases for reinsurance.
 Maintains current and accurate documentation and case management files in accordance with Case Management policy and procedure.
 Maintains confidentiality of information in accordance with department and corporate policies.
 Establishes and maintains good working relationships within the Case Management department, with other HealthPartners departments, and with other health team participants.
 Assists supervisor in maintaining a cohesive Case Management team by contributing to a collaborative, respectful, and diverse environment.
 Maintains knowledge of and effectively uses automated applications and systems.
 Identifies deficits in technological literacy and seeks appropriate training under guidance of supervisor.
 Participates in ongoing independent study and education-related professional activities to maintain and increase knowledge in the areas of Case Management, patient care services, and benefit packages for development of effective case.
 Maintains current, active Minnesota nursing licensure.
 May maintain current, active nursing licensure in other states as assigned.
 Willingly participates in various committees, task forces, projects, and quality improvement teams, as needed and assigned.
 Performs other duties as assigned.

REQUIRED QUALIFICATIONS: (Minimum qualifications needed for this position)
• Registered Nurse with current license in the State of Minnesota, or equivalent; BSN preferred.
• Minimum of 3 years clinical practice experience in an acute care setting; minimum of 3 years relevant utilization review, discharge planning, or case management experience; and current clinical knowledge.
• Demonstrated effective, independent nursing judgment and skills.
• Demonstrated skill and experience in effectively collaborating with care team members, using a high level of expertise in written, oral and interpersonal communication.
• Demonstrated working knowledge of quality improvement, utilization management, benefit plans, fiscal management, and various payment methodologies preferred. Understanding of healthcare and/or HMO industry.
• Demonstrated skill in effective use and management of automated medical management systems.
• Demonstrated flexibility, organization, and appropriate decision-making under challenging situations.
• Basic computer skills

HealthPartners is nationally acclaimed for providing outstanding patient care and we offer an excellent salary and benefits package. HealthPartners is an Equal Opportunity Employer.
For more information and to apply go to www.healthpartners.jobs and search for job ID 23344.

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