Serves as mentor and preceptor to care management staff while coordinating the utilization of healthcare resources, including transition planning, while facilitating the achievement of clinical, quality, financial and member satisfaction goals across identified risk populations
PRINCIPAL DUTIES AND RESPONSIBILITIES:
Perform ongoing telephonic and/or embedded case management activities of assessment, problem identification, planning, implementation, coordination, monitoring, and evaluation of members. Stratifies and/or validates member level of risk during each transition process and interaction with the member.
Collaborates with members, caregivers and members of the multi-disciplinary care team to develop a member centered plan of care to meet identified member care goals and outcomes
Develop, implement, evaluate and revise case management care plans according to case management eligibility criteria, contractual guidelines and members physical and psychological needs throughout the continuum of care
Identifies system issues that serve as barriers to care. Participates in development and implementation of strategies to remove barriers and promote resolution through coordination of a problem solving process
Promote member wellness and autonomy through advocacy, communication, education, and identification and referral to community resources or other case management programs such as disease management programs
Collaborate with healthcare professionals throughout the care continuum to facilitate the transition of the member/beneficiary to the appropriate level of care.
Demonstrates knowledge of utilization management and care coordination processes and current standards of care as a foundation for transition planning, complex case management and disease management activities
Confers with Medical Directors regarding complex cases requiring physician input regarding the treatment plan or physician to treating physician collaboration
Serves as preceptor to all new orientees
Receives Super-user training on a variety of programs, IT software, educational
presentations and work with staff in a Super-user capacity to ensure staff compliance
Actively participates in a defined departmental committee.
Mentor staff in various aspect of training related to the principles of practice and care coordination in adherence set forth by the Commission for Case Management
Performs assigned work safely, adhering to established departmental safety rules and practices. Reports to supervisor, in a timely manner, any unsafe activities, conditions, hazards, or safety violations that may cause injury to oneself, other employees, members and visitors
Performs all other related duties as assigned by Manager/Director
EDUCATION AND EXPERIENCE REQUIREMENTS:
Registered Nurse with BSN required; experience in Utilization Management or Case Management preferred
Active DE RN Licensure, in good standing.
Case Management Certification required
KNOWLEDGE, SKILL, AND ABILITY REQUIREMENTS:
Strong interpersonal skills relative to member, caregiver, professional and team interactions
Strong organization skills
Demonstrated ability to manage a large population of beneficiaries/members
Demonstrated critical thinking skills and the ability to prioritize workload
Ability to exercise clinical judgment and autonomous decision making
Ability to apply knowledge of case management and utilization management principles and practices.
Ability to ambulate within an office setting (walking, stairs, etc.)
Frequent sitting, standing and lifting loads of 5-10 pounds.
Internal Number: JR50075
About Christiana Care Health System
Christiana Care Health System is headquartered in Wilmington, Delaware and is one of the country's largest health care providers, ranking 21st in the nation for hospital admissions. Christiana Care is proudly a Nurse Magnet recognized institution. Christiana Care Health System is also one of the largest health care providers in the mid-Atlantic region, serving all of Delaware and portions of seven counties bordering the state in Pennsylvania, Maryland and New Jersey. A not-for-profit, non-sectarian health system, Christiana Care includes two hospitals with more than 1,100 patient beds, and is a major teaching hospital with two campuses. Christiana Care is continually recognized for excellence on a regional and national level. Our role in the community is expressed in the Christiana Care Way: "We serve our neighbors as respectful, expert, caring partners in their health. We do this by creating innovative, effective, affordable systems of care that our neighbors value."Christiana Care is a great place to work because we value diversity and recognize it to be a core part of our success. Because of the diversity of our employees, affiliated health professionals and volunteers, we are... positioned to meet the unique needs of our patients and community. We acknowledge and celebrate the uniqueness and talent of each employee. Because of our talented workforce we are able to provide a quality healthcare experience to our patients and community. We strive to create an inclusive environment in which individual diversity can be leveraged and thrive. Christiana Care Health System is an equal opportunity employer, firmly committed to prohibiting discrimination, whose staff is reflective of its community and considers qualified applicants for open positions without regard to race, color, sex, religion, national origin, sexual orientation, genetic information, gender identity or expression, age, veteran status, disability, pregnancy, citizenship status, or any other characteristic protected under applicable federal, state, or local law.