Case Manager Specialty RN Job Description

Case Manager Specialty RN Job Description

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Case manager specialty RN provides project management support to other health plan strategies and opportunities to support our Medi-Cal members and state partners.

Case Manager Specialty RN Duties & Responsibilities

To write an effective case manager specialty RN job description, begin by listing detailed duties, responsibilities and expectations. We have included case manager specialty RN job description templates that you can modify and use.

Sample responsibilities for this position include:

Provide decision support where multiple treatment options are available
Work with members on opportunities to close gaps in their overall health status Collaboration with Health Advisor team members such as nutritionist, pharmacist, behavioral clinician, MD and member's provider
Manages, coordinates and reviews the work of assigned staff for a single business line
Ensures achievement of unit financial goals and customer service/satisfaction goals
Audits case management staff routinely to ensure compliance with regulatory requirements and URAC standards
Maintain ongoing responsibility for caseload which entails assessment, education and coordination of care
Monitor adherence to care plans, evaluate effectiveness, monitor patient progress in a timely manner, and facilitate changes as needed
Identify gaps or barriers in treatment to promote member health and wellness and member satisfaction
Educate members on cancer - related issues to provide treatment knowledge and advocacy
Increase and maintain cancer knowledge to enhance treatment protocols assigned to cancer patients

Case Manager Specialty RN Qualifications

Qualifications for a job description may include education, certification, and experience.

Licensing or Certifications for Case Manager Specialty RN

List any licenses or certifications required by the position: ACLS, BLS, CDE, PICC, ONS

Education for Case Manager Specialty RN

Typically a job would require a certain level of education.

Employers hiring for the case manager specialty RN job most commonly would prefer for their future employee to have a relevant degree such as Bachelor's and Master's Degree in Nursing, Health Care, Healthcare, Education, Department of Education, Science, Nursing Education, Graduate, Health, Management

Skills for Case Manager Specialty RN

Desired skills for case manager specialty RN include:

Regulatory requirements and accreditation standards
Maternal/fetal medicine
Pregnancy complications strongly
Diabetes
Preferably gestational diabetes strongly
Access and Powerpoint
Case management standards
Excel
Medi-Cal and Medicare benefits and understands Managed Care
Medicare and Medi-Cal health coverage

Desired experience for case manager specialty RN includes:

Minimum two (2) years of clinical experience as an RN in an acute care or ambulatory care setting required
Case Management Certification or certification in the area of specialty preferred
Minimum two (2) years clinical experience as an RN in an acute care or ambulatory care setting required
Case Management Certification or certification in Orthopedics preferred
Minimum two (2) years recent (within the past three (3) years) clinical experience in Maternal Child Health, FCC, Ob/Gyn or Women's Health in acute care or ambulatory care
Minimum two (2) years of clinical experience in Oncology

Case Manager Specialty RN Examples

1

Case Manager Specialty RN Job Description

Job Description Example
Our company is looking for a case manager specialty RN. If you are looking for an exciting place to work, please take a look at the list of qualifications below.
Responsibilities for case manager specialty RN
  • Acknowledge patient’s rights on confidentiality issues, maintains patient confidentiality at all times, and follows HIPAA guidelines and regulations
  • Review medical records to determine WTC relatedness for potential program coverage and communicate results of the review to members
  • Communicate with providers to prior authorize tests and procedures related to a members certified condition as it relates to program coverage
  • Watch and record the patient’s progress on a consistent basis
  • Interact with Medical Director on challenging cases to effectively resolve issues
  • Act as a subject matter expert in Cancer
  • Ensure continuity of Care Planning
  • Perform telephonic nursing support and education of patients related to their medication(s) and disease state(s) at designated intervals following our Patient Disease State Management Procedure
  • Drive improved patient outcomes by using patient interaction skills and specialized knowledge to improve adherence, side effect management including making adjustments to patient care plans to suit individual requirements
  • Report all adverse Drug Event(s) (ADEs) internally as soon as event is discovered and assist in the reviewing and reporting of submitted ADEs
Qualifications for case manager specialty RN
  • Two (2) years of experience in Ambulatory Oncology preferred
  • Ability to partner with a cross functional team locally regionally
  • Prefer background treating chronic conditions
  • Previous experience in Neurosurgery and/or Neurology preferred
  • Ability to work with outside organizations including, but not limited to CHLA, UCLA, CCS
  • Demonstrated ability to utilize/apply the general and specialized principles, practices, techniques and methods of utilization review/management, discharge planning orcase management
2

Case Manager Specialty RN Job Description

Job Description Example
Our company is growing rapidly and is searching for experienced candidates for the position of case manager specialty RN. To join our growing team, please review the list of responsibilities and qualifications.
Responsibilities for case manager specialty RN
  • Work with Pharmacy Operations, Quality Affairs, and Information Technology (IT) to maintain and implement clinical services and programs
  • Provide clinical disease state, medication and system training to staff and interns
  • Assists patients with self-management through education, visits and telephonic engagement
  • Coordinate transitions of care to ensure appropriate follow up
  • Utilize multidisciplinary care team model to manage a core panel of patients
  • Display behavior consistent with professional nursing standards and policies
  • Provide relevant case management expertise to committees and participates in quality improvement activities
  • Assist in implementing systems into the practice for increased efficiency
  • Participate in department and team meetings and committees as assigned
  • Patient program enrollment and project management
Qualifications for case manager specialty RN
  • Computer literate, knowledge of community resources, geriatric experience, and Special Need Program a plus
  • Other (VA Form 10-2850a see below)
  • Peritoneal Dialysis experience preferred, CKD, ESRD, Transplant experience preferred
  • One year paid full time PD experience within the last 3 years
  • Experience with Peritoneal Dialysis, Hemodialysis, CKD, ESRD and/or kidney transplant patient case management preferred
  • Strong written/verbal communication skills and interpersonal skills to manage multiple clients, contract relationships and Nephrologists preferred
3

Case Manager Specialty RN Job Description

Job Description Example
Our company is growing rapidly and is looking to fill the role of case manager specialty RN. If you are looking for an exciting place to work, please take a look at the list of qualifications below.
Responsibilities for case manager specialty RN
  • ONS and PICC certification heavily preferred
  • Previous Oncology experience heavily preferred
  • Advanced fetal monitoring limited ultrasound to include AFI and BPPs
  • Must have at least five (5) years of CM experience UM preferred
  • Knowledge in healthcare regulations is a plus including but is not limited to Coordinated Care Initiative which include long term services and supports and the Medi-Cal waiver programs preferred
  • Telephone outreach to members to manage and coordinate members' health issues to reach optimum healthcare outcomes while prevent ER visit and IP admission preferred
Qualifications for case manager specialty RN
  • Registered Nurse (RN) with current active licensure in South Dakota required
  • A minimum of two (2) years of clinical experience, with a focus on infusion experience preferred
  • Must have at least 5 years of CM experience UM
  • BS/BA degree or higher in a health-related field AND licensure as a health professional OR
  • Certification as a case manager OR
  • Professional certification in a clinical specialty AND three (3) years experience as a case manager
4

Case Manager Specialty RN Job Description

Job Description Example
Our growing company is searching for experienced candidates for the position of case manager specialty RN. Thank you in advance for taking a look at the list of responsibilities and qualifications. We look forward to reviewing your resume.
Responsibilities for case manager specialty RN
  • Pediatric Diabetes Case Management preferred
  • Pediatric Certified Diabetic Educator preferred or obtained within one year of hire
  • Bilingual Spanish or Vietnamese a plus
  • Previous experience in an Addiction Medicine, Psychiatry or Pain Management Department preferred
  • Strongly preferred experience working with Transgender Community or Lesbian, Gay and Bi-Sexual Community
  • This position will require case management direct patient clinical care
Qualifications for case manager specialty RN
  • Documentation in electronic medical records preferred
  • Experience requires care coordination of services across the care continuum covering medical and behavioral issue, coordinating with primary care MD and MC's SNP program case managers preferred
  • Must be able to work with a team spirit, be flexible and willing to learn ongoing regulatory changes preferred
  • Must have active CA RN license without restrictions
  • Experience in Orthopaedics and surgical services preferred
  • Two (2) years clinical experience working with patients with chronic disease, diabetes, coronary artery disease, hypertension, heart failure
5

Case Manager Specialty RN Job Description

Job Description Example
Our innovative and growing company is hiring for a case manager specialty 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 case manager specialty RN
  • Dealing with Asthma Care Management population preferred
  • Heart Failure Case Management experience preferred
  • One (1) year experience in Endocrinology and working with Diabetic patients with complex insulins and insulin pumps preferred
  • Knowledge of pregnancy complications strongly preferred
  • Must have L&D or OB GYN clinic experience
  • Expert Health Connect skills required
Qualifications for case manager specialty RN
  • Current Orthopedics and or case management experience is required within at least 1 year minimum
  • Master's degree and experience in Labor and Delivery preferred
  • Prefer a minimum of two (2) yrs of paid experience in last 3 years in a dialysis setting
  • Experience as a hemo RN or PD RN in HIGHLY preferred since this candidate will coordinate and manage CKD and Peritoneal dialysis patients
  • Prefer a minimum of two (2) years of paid experience in last 3 years in a dialysis setting
  • Experience as a hemo RN or PD RN is HIGHLY preferred since this candidate will coordinate and manage ESRD patients and act as a liaison with KP contracted dialysis units

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