Telephonic RN Care Manager for ComplexCare Solutions Inc

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Telephonic RN Care Manager for ComplexCare Solutions, Inc. in Connecticut

Some responsibilities include:

Job Description:

– Performs care management as trained by ComplexCare Solutions.
– Identifies and acts upon barriers to care by using appropriate community and CCS resources including but not limited to, social workers, DME, Homecare etc…
– Reduces hospitalization and readmission rates by utilizing care management
– Follows CCS policies & procedures and best practices including but not limited to:
– Documentation-Assessments and reassessments of body systems, environment, social, behavioral, financial and functional abilities
– Discharge planning
– Productivity standards: CM will connect with 8 members a day
– PHV visits within 48-72 hours of discharge
– Responsible for enrollment assessments of assigned patients that includes evaluation of physiological, psychosocial, environmental, financial, and health-related behavior domains
– Establishes a plan of care with patients, providers, and payers that identifies and continuously reassesses cost-efficient appropriate levels of care
– Enhances communication and collaborative relationships with multidisciplinary healthcare team members
– Emphasizes continuity of care, thus reducing or eliminating fragmentation, duplication, and gaps in treatment plan
– Acts as a patient advocate protecting privacy and confidentiality issues
– Provides patient education, monitoring of health needs, and coordination of community resources
– Prevents adverse patient occurrences when possible and intervenes quickly if prevention is not possible, thereby minimizing poor outcomes
– Facilitates patient empowerment and quality of life by promoting educated, independent patient choice on all aspects of care
– Collects quality review data to support outcome measurements
– Maintains a comprehensive working knowledge of community resources, payer requirements, and network services for target population
– Identifies opportunities for health promotion and illness prevention
– Demonstrates accountability for own professional practice by participating in educational programs that increase case management knowledge base and skill set
– Participates in practice case studies

Education/Experience Requirements:

– Registered Nurse with current state licensure
– Minimum of 5 years of experience in a case management, clinical or discharge planning role – one year minimum experience in case management preferred
– Experience with Medicare/Medicaid Skilled visits within last year
– Strong professional level of knowledge and experience in the adult population and chronic disease management
– Maintains current CPR certification
– Valid Driver License
– OASIS experience preferred within last year
– Homecare experience required

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