CASE MANAGER RN - DISEASE MGMT in CANTON, Ohio at Aultman Health Foundation

PURPOSE OF POSITION:

The primary purpose of the Disease Management (DM) Behavioral Health Nurse is to perform assigned duties in an efficient, cost-effective manner in accordance with the established policies and procedures of the Clinical Quality Department. The role of the DM Behavioral Health Nurse is to evaluate member care needs, prioritize interventions and maintain confidentiality for this at-risk population. The role also includes assuring compliance in recommended preventative and behavioral health specific measures as defined by Healthcare Effectiveness of Data Information Set (HEDIS), National Committee for Quality Assurance (NCQA), and as identified through population health. Assurance is obtained by enrollee communication as well as provider outreach. Some responsibilities may be shared with other personnel. The Disease Management Behavioral Health Nurse must provide efficient quality service at all times.

RESPONSIBILITIES & EXPECTATIONS:

· Working directly with the Clinical Quality Supervisor to provide support for processes for Quality and Disease Management

· Educates internal department personnel on accreditation and quality standards

· Reviews department policies, procedures, documents for compliance with accreditation and quality standards

· Assists in ongoing audits on standard compliance

· Assists department with current projects, and is willing to take initiative to help others.

· Assumes personal responsibility for on-going continuing education and/or professional development, including completion of annual safety education.

· Demonstrates professional and courteous communication techniques to internal and external customers.

· Maintains AultCare standards of confidentiality.

· Maintains accurate follow-through skills relating to assigned tasks.

· Process Improvement: Continuously reviews, recommends and implements improvement steps.

· Seeks supervisory guidance/approval as appropriate.

· Portrays professional image: follows dress code; communicates with internal and external customers in a professional manner, including appropriate verbal and written grammar.

· Promotes and demonstrates professional standards to enhance the development of the department.

· Practices ethical conduct

· Meets acceptable attendance and punctuality expectations (excluding FMLA)

· Comply with policies, procedures, code of conduct, Ohio Nurse Practice Act, NCQA, HEDIS, the Health Insurance Portability and Accountability Act of 1996 (HIPAA) and other governing and accrediting bodies.

· Demonstrate honesty and integrity in all functions and relationships.

· Accurately report and document pertinent information.

· Consistently demonstrate ability to multi-task and prioritize work in accordance with organizational position and necessity.

· Maintain accurate and complete documentation in electronic data systems.

· Maintain superior quality in all job functions, contributing to the successful attainment of departmental/organizational quality goals.

· Participate in department's Quality and Chronic Care Improvements projects.

All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, age, national origin, disability, or veteran status. AultCare is an EEO/AA Employer M/F/Disability/Vet.

The above statements reflect the general duties considered necessary to describe the principle functions of the job as identified, and are not a detailed description of all the work requirements that may be inherent to this position.

QUALIFICATIONS:

· Education: BSN preferred. Graduate of an approved School of Nursing with a minimum of 4-5 years' experience in cardiac nursing. Type and setting of clinical experience will be considered in lieu of the minimum 4-5 years' experience.

· Maintains current unrestricted RN licensure

· Skills: Strong skills in Microsoft Office, including Word, Excel and Outlook

WORKING CONDITIONS:

· Hours of operation, shifts as assigned. Occasional overtime may be necessary to meet deadlines. On-call hours are to be assigned as appropriate.

· Works in well-lighted, ventilated areas.

· Sits for most of the working day, although standing and occasional mobility throughout the building and to adjoining buildings may be necessary.

· Involved with personnel under various conditions and circumstances.

· Works with highly confidential data, information and situations.