Care Manager, RN Job Description
Care manager, RN
provides oversight and timely review of the Home Health caregivers OASIS/Plans of care/ documentation for delivery of home health services with goal of optimal patient outcomes and appropriate reimbursement by utilizing available resources.
Care Manager, RN Duties & Responsibilities
To write an effective care manager, RN job description, begin by listing detailed duties, responsibilities and expectations. We have included care manager, RN job description templates that you can modify and use.
Sample responsibilities for this position include:
Build linkages to community supports and resources, and assures access to medical and behavioral health care services and community social supports
Clarify the organization's plan medical benefits, policies and procedures for members, providers and community based agencies
Managing members in a telephonic disease/case management, face to face home visit program and other community settings
Assess the options for care, including use of benefits and community resources
Assessing the options for care, including use of benefits and community resources in order to update the Person Centered Service Care Plan
Conduct assessments, develop treatment plans, perform defined interventions, and generate referrals to providers, community-based resources and appropriate social services
Identify and collaborate with community resources, both internal and external, to meet the member’s needs or goals
Performing pre-authorization, concurrent and retrospective reviews of Medicare / Medicaid / Commercial members to evaluate appropriateness of admission, need for continued stay, length of stay, utilization of resources, patient outcomes, and usage of other services post-encounter
Serves as a support to social work partners in the area of medical necessity, discharge goals, Medicare criteria and disease management
Provide Care Coordination throughout the continuum of care
Care Manager, RN Qualifications
Qualifications for a job description may include education, certification, and experience.
Licensing or Certifications for Care Manager, RN
List any licenses or certifications required by the position: CCM, ABQAURP, ACM, BLS, PALS, HCP, PRI, ACLS, BCLS, CPR
Education for Care Manager, RN
Typically a job would require a certain level of education.
Employers hiring for the care manager, RN job most commonly would prefer for their future employee to have a relevant degree such as Bachelor's and Associate Degree in Nursing, Education, Science, Graduate, School of Nursing, Healthcare, Nursing Program, Social Work, Management, Social Sciences
Skills for Care Manager, RN
Desired skills for care manager, RN include:
Medicare
Utilizes accurate computer databases and documentation systems
Managed Care
Various reimbursement criteria and documentation necessary for reimbursement
Appropriate clinical goal expectations/outcomes for identified population
Disease management for health maintenance
Appropriate care-related services to match identified needs
Healthcare delivery
Community
State and federal laws and resources
Desired experience for care manager, RN includes:
Optimize both the quality of care and the quality of life for members
Coordinate with UM department on concurrent and retrospective review
Follow up with assigned nurses for clinical updates to care plan
Document coordination notes and routine contacts with the members according to the level of risk assigned to them
Participate in team care planning meetings
Managing treatment plan utilization and care under the guidance of the Senior Director, Clinical Services and Consulting Chief Medical Officer
Care Manager, RN Examples
1
Care Manager, RN Job Description
Job Description Example
Our growing company is hiring for a care manager, RN. Please review the list of responsibilities and qualifications. While this is our ideal list, we will consider candidates that do not necessarily have all of the qualifications, but have sufficient experience and talent.
Responsibilities for care manager, RN
- Beginning the discharge planning coordination process upon admission or precertification
- Coordinating care with the member, family and care team as required
- Supervision of clinicians, support and administrative staff
- Conducting individualized clinical assessment
- Assisting in the development of new disease management and complex case management programs
- Creating and maintaining logs of caseloads for reporting and to monitor effectiveness of interventions
- Recommending, coordinating and educating providers on alternative care options
- Contributing to department goals and objectives in maintaining a high quality medical delivery system through the principles of quality improvement
- Collecting accurate and timely health care data and adequately documents patient related issues, (precert, concurrent review, alternative care, discharge planning, referrals), provider related issues and appropriate use of codes (ICD-9-CM and CPT Codes)
- Maintaining appropriate logs identified by the Medical Management Department and monitors weekly for quality assurance of data entry accuracy
Qualifications for care manager, RN
- Preparing and presents Care Management and Utilization Statistics to appropriate Health Plan committees
- Working with Provider Relations Representatives by communicating office/provider concerns, needs and expectations
- Serving as a clinical liaison and educator to Health Homes and ADHC
- Refinement of policies, procedures and processes
- Participation in oversight of program protocols
- Train foster parents on relevant medical conditions, care instructions, proper use of durable equipment, medication regimens
2
Care Manager, RN Job Description
Job Description Example
Our innovative and growing company is looking to fill the role of care manager, RN. If you are looking for an exciting place to work, please take a look at the list of qualifications below.
Responsibilities for care manager, RN
- Reporting critical incidents and information regarding quality of care issues
- Ensuring compliance with all State and Federal regulations and guidelines in day-to-day activities
- Participating in monthly chart audits
- Contribute to the development of patient-focused care and initiates the process in accordance with established guidelines
- Assess member's physical, psychosocial and discharge planning needs through communication with appropriate hospital staff, including Attending Practitioner, Utilization Review staff, Discharge Planners, and Social Workers
- Assist in identifying opportunities for and facilitating alternative care options based on member needs and assessments
- Evaluate and pre-authorize request for inpatient/outpatient, specialty care, home care, Durable Medical Equipment, and transportation services from network and out-of-network providers in accordance with departmental guidelines
- Document all interventions and telephone encounters with providers, members, and vendors in the appropriate system in accordance with established documentation standards to ensure integrity of member services provided over the continuum of care and over time
- Conducting a history and physical assessment re-assessments and other clinical assessments, as appropriate
- Assessing member / caregiver knowledge of necessary care needs, such as medication management, DME use and safety measures
Qualifications for care manager, RN
- Collaborating with other team members and the member to establish a comprehensive care plan that identifies all needs
- Facilitating discharge planning, when necessary
- Documenting all findings and member related communications in database
- Ensuring compliance with care guidelines and protocols
- Coordinate care and ensure that members and their families receive the care they need
- Synthesize nursing assessment findings to determine members’ areas of risk needs
3
Care Manager, RN Job Description
Job Description Example
Our company is growing rapidly and is looking to fill the role of care manager, RN. If you are looking for an exciting place to work, please take a look at the list of qualifications below.
Responsibilities for care manager, RN
- Participation.Actively participates in driving clinical and administrative compliance with care guidelines and core measures
- Competent professional practice and engaging in opportunities for professional growth
- Interviews patients and families to assess current functional status and support system
- Collaborates with the health care team to develop a plan of care by participating in patient care rounds
- Assures the discharge plan is in alignment with providing choice, assuring safety, and is timely and cost effective
- Assures the plan of care is individualized for patient's with a chronic disease to support patient/family self management following discharge
- Facilitates the safe transfer of patients to alternate level of care settings, assuring appropriate exchange of information among all caregivers
- Assists with scheduling discharges, pre planning discharges and identifying discharge goals during patient care rounds to assist with patient flow on the units
- Helps to identify strategies for reducing length of stay and appropriate utilization of services
- Utilizes criteria including clinical pathway data and implements strategies to resolve controllable variances
Qualifications for care manager, RN
- Must contribute to the organization's goals and objectives and support the organizational strategic plans
- 5+ years of clinical experience in of the hospital’s service lines (SCI, Pediatric orthopedics, Burn care, Cleft lip and palate) preferred
- AZ State Licensed Registered Nurse
- Or case management
- Knowledge of utilization management procedures, mental health and substance abuse
- Discharge Planning background
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Care Manager, RN Job Description
Job Description Example
Our company is looking to fill the role of care manager, RN. Please review the list of responsibilities and qualifications. While this is our ideal list, we will consider candidates that do not necessarily have all of the qualifications, but have sufficient experience and talent.
Responsibilities for care manager, RN
- Communicate with clients and multidisciplinary team by providing client related health information
- Applying care management standards and maintaining HIPAA standards and confidentiality of protected health information
- Understanding Clinical Impacts
- Providing Solutions to Constituent Needs
- Providing education to promote health engagement
- Working closely with members to implement an individual plan of care
- Makes skilled assessments of patients anticipated needs at discharge
- Communicates with patients and families about the case management process and about how this enhances the team plans for patients post-hospital care
- Acquaints customers with the functions of other members of the care management team who might also need to assess and assist patient/family
- Refers patients to other members of the care management team as appropriate (social worker, transportation or equipment coordinator)
Qualifications for care manager, RN
- RN, Bachelors degree in Nursing/healthcare related field preferred
- One year of care management experience in a hospital setting
- 2+ years of prior Cse Management experience in a Hospital setting
- Discharge and Utilization Management experience in an Acute Care setting
- RN MN with MN Board of Nursing
- 1 to 3 years of work experience as an RN in a hospital setting required
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Care Manager, RN Job Description
Job Description Example
Our company is looking to fill the role of care manager, RN. To join our growing team, please review the list of responsibilities and qualifications.
Responsibilities for care manager, RN
- Makes recommendations and take actions to improve structures, systems and outcomes
- Identifies and implements strategies to support Hospital and Departmental missions and priorities
- Uses evidence-based practice to initiate change and to drive improvement strategies
- Audit charts for compliance and participate in Quality Improvement activities
- Evaluation, supervision and development of Caregivers
- Evaluation & Care Management
- Combine clinical/quality considerations with regulatory/financial/utilization review demands
- Ensure patients are receiving excellent care
- Create a balance between individual clinical needs with cost effective utilization of resources
- Understand insurance and payment system regulations and requirements
Qualifications for care manager, RN
- Must be a NYS licensed Registered Nurse
- Clean and active NYS RN license
- Computer literate in Care Management EMR
- Care Management certification preferred (CCM)
- Bachelor's degree from an accredited school of Nursiog preferred
- Valid RN license with the MN Board of Nursing