The RN Case Manager works to identify, assess, plan, coordinate, implement, monitor, and evaluate options and services for individuals requiring case management services. The goal of the RN Case Manager is to provide for quality, cost-effective outcomes for the client through collaboration and communication with the client, the family, the physician, and other members of the health care team. The RN Case Manager works from their home office and goes out into the field to hospitals, doctors offices and client homes to perform in person evaluations. This is not a 100% remote position. This is an exempt position.

Responsibilities and Duties

Responsibilities include the following:

1. Processes cases utilizing using the outcome management model and tools and/or any alternate customer specified model and tools
2. Obtains written authorization for case management services as well as release of information
3. Assesses the client/family to identify their strengths and resources; problems; psychosocial, financial, and medical history; current status; diagnosis; prognosis; functional status; goals; current treatment plan; and needs
4. Develops a plan of care with through interdisciplinary collaboration, which identifies realistic short- and long-term goals
5. Identifies, secures, and coordinates the services and resources to implement the plan
6. Monitors services being provided for continued appropriateness and reports to TPAs and insurance carrier
7. Evaluates the client’s progress, the plan, and the appropriateness of the services provided, with modifications as necessary
8. Provides ongoing instruction to the client and family regarding the injury/disease process, treatment options, and present care
9. Promotes the client’s/family’s self-advocacy skills to achieve maximum self-sufficiency
10. Has knowledge of the benefit package as well as all available funding sources and systems of care and coordinates with the payer for authorization of payment
11. Provides for in-depth reporting of outcomes encompassing clinical, functional, financial, and customer satisfaction areas
12. Demonstrates effective, accurate, and timely verbal and written communication in all work situations
13. Identifies and discloses all situations which might result in exposure to legal liability and/or are indicative of poor quality care negatively affecting the client
14. Frequently requires travel to patient appointments.
15. Performs other related duties as assigned in accordance with the necessary job function

Supervisory Responsibilities

This position has no supervisory responsibilities.

People Contact

This position requires regular interactions both within the company and outside the company in order to carry out job duties as well as company policies and procedures. Requires abilities of persuasion and cooperation. Often deals with persons of equal or higher rank.

Decision Making

This position requires frequent decision making and the ability to plan and perform unusual or difficult work with general operation methods/procedures.

Supervision Received

This position exercises considerable latitude in determining objectives and approach to assignments. Completed work is reviewed from a long-term perspective for desired results by a Manager of Case Management.

Minimum Position Qualifications

To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill, and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

Education and/or Experience:

1. Registered nurse required
2. BSN preferred
3. CCM preferred
4. Two years of full-time Managed care or hospital based case management experience required

Language Skills:

1. Ability to read, analyze, and interpret medical information, professional journals, technical procedures, governmental regulations, and standards of care
2. Ability to effectively present information and respond to questions from customers, managers, and clients as appropriate

Mathematical Skills:

1. Ability to add, subtract, multiply, and divide in all units of measure, using whole numbers, common fractions, and decimals
2. Ability to compute rate, ratio, and percent and to draw and interpret bar graphs

Reasoning Ability:

1. Ability to solve practical problems and deal with a variety of concrete variables in situations where only limited standardization exists
2. Ability to interpret a variety of instructions furnished in written, oral, diagram, or schedule form

Computer Skills:

1. Knowledge of database software, internet software, and Microsoft word processing software

Certificates, Licenses, Registrations:

1. RN license in state(s) where cases are to be managed
2. Valid driver’s license
3. Valid automobile liability insurance

Other Skills and Abilities:

1. Ability to organize and evaluate workload and prioritize projects
2. Ability to meet deadlines
3. Ability to complete multiple, simultaneous projects with accuracy and efficiency
4. Detail orientation

Physical Demands

The physical demands described are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodation may be made to enable individuals with disabilities to perform the essential functions.

While performing the duties of this job, the employee regularly is required to sit and talk or hear. The employee frequently is required to stand and walk. The employee frequently is required to use hands to finger, handle, or feel and to reach with hands and arms. The employee occasionally is required to stoop, kneel, or crouch. The employee occasionally must lift and/or move up to ten pounds. Specific vision abilities required by this job include close vision (clear vision at 20 inches or less), distance vision, peripheral vision, and ability to adjust focus.

Work Environment

The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job. Reasonable accommodation may be made to enable individuals with disabilities to perform the essential functions.

The noise level in the work environment is usually moderate.

At Will Employment

Employment at SCM Associates, Inc. is based on mutual consent, and both the employee and SCM have the right to terminate employment at will, with or without cause, with or without advance notice.