Case Manager - Registered Nurse - Population Health (Full Time)

POSITION SPECIFICS
Title: Case Manager – Registered Nurse – Population Health
FTE: 1.0 FTE  (40 hours/week)
Schedule:  Monday-Friday between the hours of 8:00am - 5:00pm
Location: Combination of remote work, onsite work at clinics (Lodi, Wisconsin Heights, River Valley, and Plain), and Sauk Prairie Hospital
Holiday Rotation:  None
Weekend Rotation: None
On Call Requirements: None
 
POSITION SUMMARY
The Case Manager- RN – Population Health coordinates and facilitates patient care activities to promote optimum and appropriate utilization of resources, improve continuity of care across the continuum, and to contribute to patient satisfaction and outcomes.  The Case Manager- RN – Population Health evaluates patient health status, facilitates the proper plan for care and manages the implementation of nursing services to meet the patient’s individual health needs.  This position acts as a patient advocate, a resource to patients, families and staff, and as a leader of the interdisciplinary team.  This position serves as a liaison between the patient and family, and the care provider.
 
This role is responsible for the coordination of SPH’s Population Health services and focuses on improving the health status and care for individuals with focused efforts around Utilization Management, Post Acute Care, Wellness Visits, Chronic Care Management, and Transitional Care.
 
POSITION TECHNICAL RESPONSIBILITIES 

1. Assist and supports development of population health care model at SPH.  Actively partner with primary care clinics, Social Workers/RN Case Manager, Population Health Program Manager, and Outreach CMA to proactively identify and resolve potential barriers and constraints.
2. Use assessment skills and appropriate risk assessment tools to identify patients with actual or potential health care needs that would require care coordination.
3. Collaborate with patient/family in establishing mutual goals based on the patient's needs or problems.
4. Explore patient's understanding and knowledge of current health status. Partners with patient to help them integrate health status changes into their life.
5. Apply nursing judgment to determine level of care assigned or delegated. Monitor, detect and anticipate early and subtle health status changes.
6. Monitor, trend and record patient response to disease, illness, treatment.
7. Coordinate care across the continuum (inpatient/outpatient/community) to assure appropriate utilization of clinical and community resources. Promptly intervenes in instances of delayed services or inappropriate utilization of resources.
8. Coordinate input from all health professionals, conduct assessments of patient/family needs and formulate a documented plan assuring continuity of care for the highest risk patients or those patients at risk for poor outcomes.
9. Conduct precertification, concurrent, and retrospective utilization management through the application of nationally recognized criteria.
10. Collaborates with Social Work, Nursing Staff, Providers and other members of the care team to integrate psychosocial management of patient/family needs.
11. Coordinate and lead family conferences and/or multidisciplinary care conferences as needed.
12. Document accurate assessments and interventions in patient’s electronic medical record in an effective and timely manner
13. Assess patient’s unique perspective and assure right education, right time, right environment for learning. Anticipate future needs and educates or refers to valid sources of information.
14. Delegate care based on situation while assuming accountability for patient outcome. Assure effective use of staffing resources. Support assistive personnel. Serve as a resource and hold assistive personnel accountable to complete delegated tasks.
15. Continually evaluate program data to further refine the referral criteria to case management; provides feedback to staff to improve the referral process.
16. Identify actual or potential variances in standards of care and system problems that could lead to errors, delays in care, complications or increased cost. Contact providers, staff and/or applicable leadership personnel to resolve these findings.
17. Integrate care coordination with disease management efforts to achieve low-cost interventions that achieve the greatest benefit and increase the accountability of patients for management of their disease.
18. Analyze data to identify under/over utilization; improve resource consumption; promote potential reduction in cost; and enhance quality of care consistent with organization strategic goals and objectives. Data includes but is not limited to predictive analysis, risk stratification, cost-benefit analyses, financial analyses, clinical outcomes, utilization, and practice patterns.

• Required:  Associate Degree in Nursing.
• Preferred:  Bachelor’s degree in nursing (BSN) or Master’s Degree in nursing (MSN)

• Required: Minimum of 2 years of nursing, case management or utilization review experience.
• Preferred: Two or more years of experience of case management and/or Utilization Review in a healthcare setting.

• Required:  Current State of Wisconsin licensure as a Registered Nurse.
• Preferred:  None

• Required: Basic Life Support (BLS) – within 3 months of hire.
• Preferred: Case Management certification. 

1. Competitive health and dental insurance options
2. Flexible paid time off to balance work and life
3. Retirement plan with immediate vesting and employer match
4. Free membership to our state-of-the-art fitness facility
5. Generous tuition reimbursement
6. Employer provided life and disability insurance
7. Free parking at facility