Integra/UHC Case Manager

Department: CNE-INTEGRA
Operating Unit Care New England
Location: , RI
Job ID: 7990
Job Status: Full Time
Shift: Days
End Date:

Primary Function

The Integra/UHC Case Manager collaborates with United Health Care, Primary Care Physicians, specialists and ancillary services to pursue cost-effective, quality focused management interventions by achieving a predetermined financial and clinical outcome. Responsible for providing ongoing communication with patients, continuing care coordinators, social workers, and physicians to ensure patients have appropriate resources/support in the community and intervening when patients are unable to be managed adequately. Tracks patients along with continuum of care, identifying patterns that have a negative cost-quality impact and assists with the development of plans for improving care.

 

Specifications

Registered Nurse with Bachelorís Degree in Nursing or equivalent, with current RI license. Minimum of 5 years related clinical experience, demonstrating recent knowledge of case management, utilization review, quality assurance, discharge planning, third party payor regulations and community health. Experience must demonstrate high level of interpersonal skills, both oral and written, analytical skills, leadership abilities and effectiveness within a team environment.

 

 

I. Application of Knowledge and Skill

  1. Collaborates with a selected group of patients to pursue cost-effective quality focused management interventions by achieving a predetermined financial and clinical outcomes
  1. Functions as a patient advocate determining exactly what community services are required and the ways to assist with securing those services
  1. Provides ongoing communication with patients, continuing care coordinators, social
    1. workers and physicians to ensure the patient has the appropriate resources/support in the community
  1. Intervenes with patients who are unable to be managed adequately due to significant variation from expected outcomes or unanticipated complications
  1. Identifies patients needing Case Management intervention through UHC data report
  1. Ensures adequate follow up care is available to the patient at case closure
  1. Tracks patients along the continuum of care identifying patterns that have a negative cost-quality impact. Summarizes specific deviations and assists with the development of plans for improving care
  1. Establishes relationships with professional and/or health-related groups within the community
  1. Shares care coordination expertise with professional and supportive personnel
  1. Documents and reports communications/interventions in an accurate, timely manner using appropriate forms and records
  2. Identifies, analyzes, and resolves patient care problems to foster significant improvements in patient care and demonstrates a commitment to improving the quality of care provided to patients.
  3. Performs other related duties as assigned