Serves as a member of the care management team of the Grocers Supply Wellness Clinic. Responsible for assessing, planning, implementing, coordinating, monitoring and evaluating the treatment options of health care services that are clinically appropriate in a timely manner. Assists the Client’s employees in achieving and maintaining the highest level of individual wellness in order to lower health care costs and create an overall healthy work environment. Assists in meeting the patient’s needs by promoting quality and cost effective outcomes. Follows the core components of the case management process by being able to coordinate and assure the delivery of service, assess physical as well as psychological factors involved in planning the patient’s care, evaluation of the benefits and calculating a cost benefit analysis. Must be knowledgeable in regards to community resources and apply the case management concepts and standards of care. Must possess strong skills in communication, empowerment, facilitation, collaboration, problem solving, as well as being an advocate to the client. Must be flexible to take on a diversity of tasks and responsibilities as the role evolves. Works under general supervision with latitude for initiative and independent judgment. Reports to the Director of Medical Management.
PRINCIPAL DUTIES AND RESPONSIBILITIES
Performs on-site case management, disease management and other wellness initiatives.
Develops, implements and maintains case and disease management care plans for complex and/or large cases.
Communicates with on-site physician or patient’s physicians on any inpatient/outpatient stays, services or procedures.
Communicates, coordinates and supports on-going health care services with physicians.
Implements strategies to ensure patient follow-up.
Develops patient/family educational plans to promote self-management.
Coordinates ongoing educational needs of patients and their families as related to their disease and self-management.
Assists the patient/family with integrating the implications of the illness recovery and health promotion into their lifestyle.
Maintains client and subscriber confidentiality at all times.
Corresponds by email or phone with each patient who is willing to work one on one with the nurse on health management.
Documents thoroughly in the Case Management database each encounter with a patient.
Follows the plan of care established with the patients primary care provider, sets goals and action steps according to the patient’s willingness for change.
Facilitates presentations to Grocers Supply employees on various topics related to health, wellness and nutrition.
Works with members of the Wellness Center team to develop educational materials and protocols based on patient/employer needs.
Stays up-to-date on continuing education, state licensures and certifications.
Performs other duties as assigned.
Experience and Education
Bachelor’s degree or Associates Degree and current RN license in the State of Texas is required. At least three years of medical/ surgical/ hospital experience is essential. Bilingual experience is required.
Experience performing case and disease management.
Certification as a Case Manager.
Background in patient education.
Experience working with physicians and other ancillary healthcare staff.
Knowledge, Skills, and Abilities
Knowledge of business correspondence, filing and general office procedures.
Knowledge of current healthcare protocols.
Knowledge of ICD-9 and/or CPT-4 codes.
Knowledge in properly interpreting plan documents for utilization review, case management, disease management and other applicable plan benefits and exclusions.
Knowledge of internal policies and procedures.
Skill with standard office operating equipment and various Microsoft Office applications.
Skill in organization.
Skill in interpersonal and written communication.
Ability to handle a diversity of tasks and responsibilities.
Ability to demonstrate leadership skills.
Ability to work independently and be self-motivated.
Ability to accurately compile data and perform detailed work.
Ability to meet deadlines.
Ability to maintain regular attendance.
Ability to maintain confidentiality of material and information.
Ability to maintain professional appearance and demeanor.
Ability to work as a member of a team.
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