Nurse Case Manager

Pacificsource Hood River , OR 97031

Posted 3 weeks ago

Looking for a way to make an impact and help people?

Join PacificSource and help our members access quality, affordable care!

PacificSource is an equal opportunity employer. All qualified applicants will receive consideration for employment without regard to status as a protected veteran or a qualified individual with a disability, or other protected status, such as race, religion, color, national origin, sex, sexual orientation, gender identity or age.

Diversity and Inclusion: PacificSource values the diversity of the people we hire and serve. We are committed to creating a diverse environment and fostering a workplace in which individual differences are appreciated, respected and responded to in ways that fully develop and utilize each person's talents and strengths.

Case management is a collaborative process that assesses, plans, implements, coordinates, monitors, and evaluates the options and services required to meet the client's health and human service needs. It is characterized by advocacy, communication, and resource management and promotes quality and cost-effective interventions and outcomes.

Clinicians incorporate the essential functions of professional case management concepts to enhance patients' quality of life and maximize health plan benefits. These functions include, but are not limited to:

  • Coordination and delivery of healthcare services

  • Consideration of physical, psychological, and cultural factors

  • Assessment of the patient's specific health plan benefits and additional medical, community, or financial resources available

Essential Responsibilities:

  • Clinician Care Managers facilitate the achievement of client wellness and autonomy through advocacy, assessment, planning, communication, education, resource management, and service facilitation.

  • Collect and assess patient information pertinent to patient's history, condition, and functional abilities in order to develop a comprehensive, individualized care management plan that promotes appropriate utilization, and cost-effective care and services.

  • Based on the needs and values of the client, and in collaboration with all service providers, the clinician links clients with appropriate providers and resources throughout the continuum of health and human services and care settings, while ensuring that the care provided is safe, effective, client-centered, timely, efficient, and equitable.

  • Clinicians have direct communication among, the client, the payer, the primary care provider, and other service delivery professionals. The case manager is able to enhance these services by maintaining the client's privacy, confidentiality, health, and safety through advocacy and adherence to ethical, legal, accreditation, certification, and regulatory standards or guidelines.

  • Interact with other PacificSource personnel to assure quality customer service is provided. Act as an internal resource by answering questions requiring medical or contract interpretation that are referred from other departments, as well as physicians and providers of medical services and supplies. Assist employers and agents with questions regarding healthcare resources and procedures for their employees and clients.

  • Practice and model effective communication skills: both written and verbal.

  • Utilize and promote use of evidence-based tools. Utilize lean methodologies for continuous improvement.

Supporting Responsibilities:

  • Meet department and company performance and attendance expectations.

  • Follow the PacificSource privacy policy and HIPAA laws and regulations concerning confidentiality and security of protected health information.

  • Perform other duties as assigned.

Work Experience: Five years clinical experience, including case management. Insurance industry experience preferred.

Education, Certificates, Licenses: Registered Nurse or Licensed Clinical Social Worker or Licensed Professional Counselor with current appropriate unrestricted state license. Certified Case Manager Certification, or equivalent, strongly desired or willingness to obtain certification within 2 years of hire.

Knowledge:
Knowledge of health insurance and state mandated benefits. Experience and expertise in case management practice including: advocacy, assessment, planning, communication, education, resource management and service facilitation. Ability to deal effectively with people who have various health issues and concerns. Knowledge and understanding of contractual benefits and options available outside contractual benefits. Knowledge of community services, providers, vendors and facilities available to assist members. Ability to use computerized systems for data recording and retrieval. Assures patient confidentiality, privacy, and health records security. Establishes and maintains relationships with community services and providers. Maintains current clinical knowledge base and certification. Ability to work independently with minimal supervision.

Environment: Work inside in a general office setting with ergonomically configured equipment. Travel is required approximately 5% of the time.

Our Values

  • We are committed to doing the right thing.

  • We are one team working toward a common goal.

  • We are each responsible for customer service.

  • We practice open communication at all levels of the company to foster individual, team and company growth.

  • We actively participate in efforts to improve our many communities-internally and externally.

  • We encourage creativity, innovation, and the pursuit of excellence.

Physical Requirements:
Stoop and bend. Sit and/or stand for extended periods of time while performing core job functions. Repetitive motions to include typing, sorting and filing. Light lifting and carrying of files and business materials. Ability to read and comprehend both written and spoken English. Communicate clearly and effectively.

Disclaimer: This job description indicates the general nature and level of work performed by employees within this position and is subject to change. It is not designed to contain or be interpreted as a comprehensive list of all duties, responsibilities, and qualifications required of employees assigned to this position. Employment remains AT-WILL at all times.


icon no score

See how you match
to the job

Find your dream job anywhere
with the LiveCareer app.
Mobile App Icon
Download the
LiveCareer app and find
your dream job anywhere
App Store Icon Google Play Icon
lc_ad

Boost your job search productivity with our
free Chrome Extension!

lc_apply_tool GET EXTENSION

Similar Jobs

Want to see jobs matched to your resume? Upload One Now! Remove
Resident Care Manager (Registered Nurse) MDS Nurse

Prestige Care, Inc

Posted 2 weeks ago

VIEW JOBS 10/30/2019 12:00:00 AM 2020-01-28T00:00 Competitive Salary - Relocation Assistance WE WILL TRAIN YOU TO BE A RESIDENT CARE MANAGER/MDS NURSE/NURSING LEADER! Did you know that we have a comprehensive training program for new Resident Care Managers/MDS nurses here at Prestige Care? We have a over 20 module training program that covers such topics as utilization review, MACC meetings, admits/discharges, risk management, paint management, MDS/observations, care planning, care conferences, crucial conversations and more. Going through this training program will set you up for success! We have a strong promote-from-within culture, and going through this program is part of your pathway to becoming a Director of Nursing with the Prestige Care Family. POSITION SUMMARY The Resident Care Manager (RCM) - Registered Nurse coordinates the daily nursing activities and care as prescribed by the physician and in accordance with accepted standards of nurse practice and regulations. Promotes a positive physical and psychosocial environment for the residents. ESSENTIAL DUTIES AND RESPONSIBILITIES * The RCM plans and directs ongoing care in collaboration with the physician, Director of Nursing Services (DNS), clinical team members, social services, physical therapy, the resident and the resident's family by tailoring care to meet individual needs of the resident. * Monitors work assignments, provides coaching, training and feedback, and assists in daily management of clinical team members including licensed nurses and Certified Nursing Assistants (CNA). Escalates pertinent information to DNS timely. * Assists with new admissions, transfers, discharges and oversees ongoing resident care ensuring documentation is current, signed, and the recordkeeping meets the policies and procedures. * Completes MDS, observations and forms as scheduled for each resident. * Conducts resident care conferences and develops interdisciplinary plan of care for each resident. * Observes, audits and reviews each resident's condition, status, and care requirements and takes appropriate action to assure care needs are met. * Develops nursing care plans for each resident that meets the individual needs of the resident and the physician recommendations. Reports changes in condition of residents that requires nursing intervention notifying the physician, Director of Nursing Services, and family. Documents all pertinent information in the interdisciplinary notes and on the 24-hour report timely and accurately. * Transcribes, implements or delegates physician orders in accordance with the relevant nurse practice act. * Assists in the investigation of resident incidents and abuse allegations with timely reporting and follow up. * Partners with DNS to maintain compliance with applicable federal, state and local standards and regulations and completes quality care and compliance audits. * Assists in the management of the Infection Control Program and Antibiotic Stewardship including acting as an Infection Preventionists (as required) and completing specialized training in infection control. Provides training to staff on infection control practices, investigates and reports incidents of infection and tracks infection data. * Participates in leadership team by actively contributing in decision making, grievance follow up, building and company-wide initiatives and attending leadership team meetings such as stand up, Managing Acute Care Conditions (MACC), Nutrition at Risk (NAR), Utilization Review (UR), Quality Assurance Performance Improvement (QAPI) and other meetings as required. * Participates in clinical on-call rotation as assigned; including weekend on-call duties and covering clinical shifts as needed. * Attends and participates in continuing education programs keeping CEUs up to date and attends and participates in training, in-services, and staff meetings. * Other duties as assigned. COMPANY-WIDE RESPONSIBILITIES * Demonstrates Core Values of Respect, Integrity, Commitment and Trust. * Supports a dignified and caring atmosphere with residents, residents' families, visitors and staff. * Protects privacy and confidentiality of information pertaining to residents, employees, the facility, and company information and records. * Maintains a safe and secure working environment and practices safe working habits. QUALIFICATIONS AND EXPERIENCE The Resident Care Manager-RN must have a current, unencumbered RN license. Minimum of 1 year working in geriatric nursing, including experience with medication administration, delivery systems and pharmacies. One year in supervisory/management position, with experience with budgets, staff development, training and scheduling preferred. Ability to creatively problem solve in both resident care and employee management situations. Must be a team player, well organized, and flexible. EDUCATION The Resident Care Manager/MDS Nurse - Registered Nurse must have a Bachelor of Science in Nursing or Associate Degree in Nursing. KEYWORDS: Nurse, MDS, MDSnurse, MDS Nurse, senior care, skilled nursing, Registered Nurse, Nurse Manager, Nurse Leader, Unit Manager, acute, hospital, Nursing Leadership EOE/M/F/VETS/DISABLED Hood River Care Center Hood River Care Center is located in a residential neighborhood nestled among the pear and apple orchards overlooking the beautiful Hood River Valley. Our staff believes that every resident is an individual and we take great care to communicate and learn the activities that add comfort to their day. With that goal in mind, we provide quality health care programs that promote rehabilitation of the whole person -- physically and emotionally – always striving for quality through deliberate and constant improvement of services. In addition to the many amenities, Hood River Care Center offers Prestige's award-winning Expressions Memory Care Program, designed to make our residents feel accepted, important, comfortable… at home. Expressions creates a buffer against fear and the stress of dementia and other forms of cognitive impairment through activities that stimulate the body and mind, and enrich the life of our residents. U.S. News evaluated more than 15,000 centers nationwide on key service differentiators, including quality of care, safety of residents, health inspection grades, staffing and more. Our Hood River Care Center earned high ratings in these categories and was awarded the "Best Nursing Home" distinction by U.S. News! Learn more about this prestigious distinction here: https://bit.ly/2XQPsdb. Join our award winning care team today! Any Questions? Contact: HoodRiverAdministrator@prestigecare.com Prestige Care is about people helping people, and is rooted in a philosophy of caring based on our core values - respect, integrity, commitment, and trust - that are at the center of all we do. Our mission is to provide quality care, guided by a compassionate heart and our promise is to personally touch lives every day. At Prestige we offer a dynamic and collaborative environment where you will not only make a difference in the lives of others every day; you have the opportunity to grow professionally, learn new skills and advance your career. Build Your Healthcare Career with Prestige Care Prestige Care is a family-owned and operated industry leader in the skilled nursing, assisted living, and rehabilitation space. As a Prestige Care team member, you are more than just an "employee," you are part of our family. With a company focus on career development and advancement, there are many opportunities for advancement at our over 80 communities and care centers in 8 Western states. The healthcare career opportunities are endless and we look forward to collaborating with you to achieve your professional goals. Check out the career path that you can take with Prestige Care below: We also offer a full benefits suite to eligible employees that includes the following: * Medical, dental, and vision coverage * HSA/FSA accounts * Employer paid group life and AD&D insruance * 401(k) plan with company match * Paid vacation, sick days, and holidays * Employee Assistance Program * Commitment to career development and continuing education * Scholarship/ tuition reimbursement * Flexible scheduling * Employee discounts: cell service, theme parks, and so much more! * Benefits may vary by location Join our nationally-recognized and award-winning care center! We were 1 of only 17 care centers in the entire state of Oregon to receive a 2019 "Bronze" National Quality Award through the American Health Care Association, which honors long term and post-acute care providers that have demonstrated their commitment to improving the quality of care for seniors and individuals with disabilities! Join our high-performing care team today! Prestige Care, Inc Hood River OR

Nurse Case Manager

Pacificsource