The Ambulatory Orthopedic Nurse Case Manager plays a vital role in providing patient-centered case management to patients with orthopedic conditions across the continuum of care settings; in close collaboration with participating physicians and their teams.
The case manager is a member of a multidisciplinary team, working with their Supervisor, Manager, Director, and Managed Care Medical Director to attain optimal results by impacting the delivery of quality care in a holistic approach to the patient and family. They coordinate care with providers, staff, external providers and facilities.
Education/Certification/Licensure (enter the degree or certification, registration, licensure type in the appropriate box)
or Equivalent Ed/Exp
Experience (number of years and type of work experience/environment needed to be fully proficient in the job. This should reflect the minimum requirement, unless noted as preferred).
Active, unrestricted CA RN license , Current, unrestricted CA Drivers License
Current, BLS certification
BSN from an accredited US nursing program
Minimum of three (3) years acute care nursing experience
Case management, home care, or discharge planning experience required minimum one year
Case management certification, or expected to attain CCM (case management certification) within two years of hiring.
Experience working in EPIC and EPIC Tapestry
Public Health Nursing Certification
Knowledge (information gained through education or experience that incumbent would draw upon to perform this job. This should reflect the minimum requirement, unless noted as preferred).
Knowledge of orthopedic conditions and surgical treatment options and its effects on patients and caregivers.
Computer skills including Microsoft Office. EPIC knowledge preferred.
Knowledge of applicable NCQA standards, state and federal regulations.
Knowledge of the health care financial environment and requirements for various payer types, e.g., Commercial, CMS, CCS for HMO and PPO cases, and ability to apply Managed Care concepts.