Job DescriptionJob Description
We have a new opening for a Registered Nurse - Case Management at Nellis AFB in North Las Vegas, NV.
Duties:
• Develop and implement a comprehensive Case Management plan/program in accordance with the facility’s goals and strategic objectives.
• Perform data/metrics collection on identified program areas; analyzes and trends results, including over- and under-utilization of healthcare resources. Identifies areas for improvement and cost containment. Report case management patterns and provides feedback in a timely manner.
• Proactively identify and evaluate patients and families for case management from a variety of resources such as discharge/disposition, planning, referrals, the Medical Evaluation Board (MEB) process, the healthcare system, employers, and facility staff. Conduct systematic, on-going, thorough collection of patient’s physical, emotional, psychological, social, and medical status and information via direct patient contact and other relevant sources such as professional and non-professional caregivers, medical records, family/caregiver interviews to include caring for those designated with diagnoses of wounded Warrior, Ill and Injured, TBI and PTSD.
• Develop an appropriate patient-specific plan of care to include short and long term goals, objectives and actions. Coordinate, collaborate, and obtain approval of the plan among the patient, family/caregiver, primary provider, and other members of the healthcare team.
• Ensure coordination of care delivery processes, to include alternate healthcare settings and the home environment, for the purposes of enhancing the patient's health and wellness, safety, productivity, and quality of life, and for providing the most beneficial, cost-effective health care. Develop, utilize, and maintain a variety of military and community resources to optimize access to services and medical care. Ensures timely and appropriate provision of services.
• Verify eligibility of beneficiaries using Defense Eligibility Enrollment Reporting System (DEERS). Obtain pertinent information from patients/callers and updates data in MHS Genesis, local referral database, and other office automation software programs as appropriate and directed.
• Interpret and evaluate data appropriately in collaboration with Health Care Integrator and Group Practice Manager.
• Document and update the treatment plan as needed in accordance with existing DoD, AF, local facility, and other agency guidelines. Maintain documentation and data collection in accordance with DoD, AF, local facility, and other specified agency guidelines. Conduct and/or participates in program evaluation as directed.
• Review referrals to case management for appropriateness, medical necessity, and if the needed service is a covered benefit according to appropriate health plan. If unsure, coordinate with TRICARE Regional Office Clinical Liaison Nurse or review TRICARE and Health Net Operations Manual.
• Receive and make patient telephone calls, written, or e-mail correspondence regarding specialty clinic appointments and referrals following facility-specific processes.
• Perform routine monitoring of referral management MHS GENESIS queue to ensure patients referrals are appointed and closed out.
• Monitoring and evaluation may include, but is not limited to: patients adherence and response to the treatment plan; timeliness of patient and family/caregiver contact and follow-up; identification of variances, patterns or trends from established practice guidelines and/or standards; established outcome measurements; results of interventions, treatment delivery and timeliness of care; and utilization of resources. Monitor and evaluate the facility’s case management program per DoD, AF, DHA and local policies and guidelines.
• Travel outside of the local facility and/or off the military installation may be necessary. When needed, travel to the patient's military living quarters during inspections to inspect and advocate for the patient's medical and special physical requirements and to verify that the housing being provided is safe, accessible, and facilitates the care and recovery of the member. Travel will be reimbursed IAW Para 2.4.1 of the Contract.
• Monitor active duty, reserve/guard admissions to civilian hospitals and via notifications from Referral Management as required.
• Serve as a liaison with headquarters, TRICARE and Health Net regional offices, facility staff and professional organizations concerning Case Management practices.
• Collaborate with staff/departments, including, but not limited to: Executive Management, Resource Management, Medical Records, Patient Administration, Group Practice Managers, Health Care Integrators, Coders/Coding Auditors, Population Health Nurse Consultants, Medical Management, Referral Management, TRICARE Operations, patient care teams, Quality Improvement, and the Managed Care Support Contractors.
• Collaborate with Recovery Care Coordinator on the status of those enrolled in the Wounded Warrior Program.
• Coordinate and participate in interdisciplinary team meetings, designated facility meetings, and Care Coordination meetings. Share knowledge and experiences gained from own clinical practice and education relevant to nursing and case management.
• Participate in the orientation, education and training of other staff. May serve on committees, work groups, and task forces at the facility. Provide relevant and timely information to these groups, and assists with decision-making and process improvement. Participate in customer service initiatives, performance and quality improvement measures and medical readiness activities designed to enhance health services.
• Must maintain a level of productivity and quality consistent with: complexity of the assignment; facility policies and guidelines; established principles, ethics and standards of practice of professional nursing; the Case Management Society of America (CMSA); American Accreditation Healthcare Commission/Utilization Review Accreditation Commission (URAC); CAMH; (AAAHC); Health Services Inspection (HSI); and other applicable DoD and Service specific guidance and policies. Must also comply with the Equal Employment Opportunity (EEO) Program, infection control and safety policies and procedures.
• Follow applicable local facility /AF/DoD, DHA instructions, policies and guidelines.
• Complete medical record documentation and coding, and designated tracking logs and data reporting as required by local MTF/AF/DoD, DHA instructions, policies and guidance.
• Complete all required electronic medical record training, facility-specific orientation and training programs, and any AF/DoD, DHA, AFMRA mandated Case Management training.
• Ensure a safe work environment, employee safe work habits and patient safety IAW regulatory agencies, infection control policies, and process improvement initiatives. Promote and contribute quality performance, performance improvement programs, nursing peer review and nursing practice in a setting that supports professional practice and sets a positive example; identify and deliver excellence in the delivery of nursing services and care to patients/residents; introduces and disseminates best practices in nursing services. Proactively identify process issues that could lead to negative patient outcomes and participates in the appropriate safety reporting processes for the facility.
• Attend AMRO (Airmen Medical Readiness Optimization) meetings, in-patient huddles/rounds, clinic huddles to determine need for assessment of potential case management services.
Schedule:
Monday - Friday, 8 to 10 hour shifts, between 7am and 6pm
No Call, No Weekends, No Holidays!
Requirements
Minimum Qualifications:
Degree: Possess a Bachelors degree in Nursing from a college or university accredited by Accreditation Commission for Education in Nursing (ACEN) or the Commission on Collegiate Nursing Education (CCNE). Advanced degree in a health care discipline or a masters in community health is desirable. National certification in a related field (e.g. community health, ambulatory nursing, or occupational health, etc.) is recommended.
Experience: A minimum of five years of experience as a registered nurse with at least 12 months of experience in disease management within the last 24 months.
- Experience in case management, condition management, discharge planning, utilization management, Telehealth, and performance improvement is preferred.
- Computer skills in data management, Microsoft Office Suite: Outlook, Word, Excel (pivot tables), Power Point, Publisher and Access are desirable.
- Strong background in inpatient and outpatient nursing specialties, ambulatory care nursing, prevention, health promotion, disease/condition management, case management, discharge planning, and clinical data analysis is highly desirable.
Certification: Certified Case Manager by Commission for Case Management (CCM) -OR- American Nurses Credentialing Center (ANCC) in full time clinical case management with children, families, seniors, or groups preferred. -OR- can be certification eligible if a BSN with 2 years full-time case management experience in past 3 years. Must obtain certification within 1 year of starting contract
Licensure: Current, full, active and unrestricted license as a Registered Nurse
Life Support Certification: Possess a current AHA OR ARC BLS Healthcare Provider certification.
Security: Must possess ability to pass a Government background check/security clearance.
We are an equal opportunity employer and a drug free workplace. All applicants selected for employment are required to submit to a background check and pre-employment drug test.
Benefits
Excellent Compensation & Exceptional Comprehensive Benefits:
Paid Vacation, Paid Sick Time, Plus 11 Paid Federal HolidaysMedical/Dental/Vision, STD/LTD/Life, Health Savings Account available, and moreAnnual CME Stipend and License/Certification ReimbursementMatching 401K
Base salary: $50.00 - $62.00/hr depending on experience
Sign-on Bonus: $2,000 paid with first paycheck!
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