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Case Manager Nurse

Case Manager | Harrisburg, PA | Contract

Job Description
Case Manager Nurse
Work Location: Harrisburg, PA

Job Summary/Description
Case Manager Nurse will perform the six (6) essential activities of case management: assessment, planning, implementation, coordination, monitoring, and evaluation. To follow the Standards of Practice for Case Management as established by the Case Management Society of America (CMSA). Be available as a full-time consultant approximately 37.5 hours per week.

Job Duties/Responsibilities/Functions (including but not limited to)
• Assess the need for case management intervention by obtaining and objectively evaluating data, including clinical information, medical history, level and location of care, functional status, psychosocial and environmental factors;
• Documents assessment, plan of care and timetable for implementing interventions;
• Facilitates the implementation of the care plan by optimizing available benefit, comparing the benefits and cost of care.
• Plan alternatives based on recipient needs and investigate opportunities to use available community resources and educates the recipient, family or significant other, physician and providers relating to the availability of community resources and services;
• Utilize Medical Assistance regulations for prospective review of medically necessary services and procedures
• Work closely with the PCP, specialists and other providers to support the treatment plan and achievement of goals developed for and by the recipient or caregiver;
• Set expectations for timely reports within the vendors providing services;
• Measure effectiveness, necessity and efficiency of the care plan and make revisions as needed;
• Collaborates with enrolled providers to assure recipients are referred to the appropriate providers to deliver care and services to recipients in a cost-effective manner;
• Works closely with medical directors to implement appropriate action plans;
• Attends the Medical Directors Meetings;
• Participates and provides feedback at MCO Contract Management Meetings, QQRM & others as assigned;
• Members of the Special Needs Resource Facilitation Team (RFT) to ensure the transition of care for HC members who receive shift care under EPSDT to waiver at age 21;
• Member of the Complex Care Team and participates in bi0weekly meetings to address the needs/issues of HC member who are involved with multiple program offices due to their complex needs;
• Represents the Department at high level meetings requiring their clinical background;
• Provides clinical evaluation of Age Out cases;
• Responsible for annual/quarterly completion of SMART related to Special Needs Section of HC Agreement. This includes onsite visits to the MCO's for monitoring;
• Responsible to work with the M&C staff in completing the Readiness Review process for areas related to Special Needs;
• Assists Special Need Unit Supervisor in completion and analyzing of various monthly/quarterly reports;
• Collaborates with the inpatient review nurses to coordinate discharge planning to an appropriate level of care;
• Effectively manage a caseload of up to 60 - 75 cases;
• Maintains management records in accordance with professionally accepted standards
• Participates in the development of desktop procedures;
• Collaborate with other bureaus/contractors to assure continuity of care;
• Performs other duties as assigned by the Bureau Director or medical directors

Minimum Qualifications
• Possess an active Pennsylvania Registered Nurse license
• CCM (Certified Case Manager) required-, administered through CCMC (Commission or Case Management Certification) or the National Academy of Certified Care Managers or American Nurses Credentialing Center; or attain certification after 12 months of continuous employment from the date of hire. Continued employment would be conditional on the candidate obtaining certification within the said time
• Possess a documented work history of two or more years of experience in case management or a related field
• Possess basic computer skills, including familiarity with Microsoft Office programs
• Be available as a full-time consultant approximately 37.5 hrs. per week

About InGenesis
InGenesis is dedicated to placing people in positions that preserve life, improve lives and inspire others. This does not happen without passionate people, skilled colleagues who are motivated to create innovative solutions and deliver superior service to our clients. Founded in 1998, InGenesis manages thousands of employees, including pioneering healthcare, science, technology and pharma professionals. The workforce solutions company includes almost half of the Fortune 500 in its nearly 300 clients. It is recognized as one of the largest healthcare staffing firms, and InGenesis is the largest minority/women owned healthcare staffing firm in North America.

EEOC Statement
We support a diverse workforce and is an Equal Opportunity Employer who does not discriminate against employees and applicants for employment on the basis of race, gender, color, religion, national origin, age, sexual orientation, gender identity, genetic information, disability, veteran status, or other classification protected by law.