RN Behaviour Health Case Manager

Job Summary

· Provides Disease Management (DM) services to TRICARE beneficiaries.

· The DM nurse will collaboratively assess, plan, implement, coordinate, monitor and evaluate the beneficiary’s health and psychosocial needs with a focus on empowering the beneficiary to successfully manage their chronic condition.

· The DM nurse will partner with the interdisciplinary care team to identify appropriate care to prevent complications related to chronic conditions and minimize the risk of potential exacerbation through the use of evidence-based condition-specific education and coaching.

· This role requires the individual to develop care plans in collaboration with providers, patients, families as appropriate and assesses the effectiveness and outcomes to improve individual health status.

Working Conditions

· Ability to cover any work shift

· Ability to work overtime, if needed

· Onsite: Works within a standard office environment

· Remote: Private and secure workspace and workstation with high-speed internet is required

· Extensive computer work with prolonged sitting, wearing of headset, typing, speaking on a phone

Government Reporting

· Direct

Education & Experience

Required

· Current, unrestricted RN licensure to independently work within scope of practice within state of residence

· U.S. Citizen

· The ability to obtain multi-state licensure; if a resident in a NCL state

· Minimum of three years clinical experience

· Experience in case management, care coordination or discharge planning in an acute, ambulatory or specialty disease management program settings in a healthcare system or managed care organization (MCO).

Preferred

· Disease Management experience with a managed care organization (MCO)

· Bachelor’s degree other related health field

· Knowledge of government healthcare programs, TRICARE, and Medicare/Medicaid

Key Responsibilities

· Assess beneficiaries to identify medical, physical, and psychosocial needs to support the beneficiaries’ overall goals of care.

· Ensure and evaluate clinical appropriateness of care plans by incorporating assessment findings against evidence-based guidelines, clinical reasoning and clinical practice guidelines.

· Provide education and coaching specific to the beneficiary needs to prevent exacerbations or worsening chronic conditions.

· Manage activities necessary to ensure appropriate utilization and access to resources while maintaining optimal standards of care.

· Review, identify and assist with identification and facilitation of resources related to health disparities identified through SDOH assessment.

· Participates in the development of measurable outcomes, ensures measures are in place to monitor the impact of programs and services on the health status of beneficiaries being managed.

· Facilitate transfer of beneficiaries between the different regions and within the regions by collaborating with the military liaison to support the transition with minimal disruption.

· Adhere to URAC standards, TRICARE policy, contractual requirements, and nationally recognized practice standards.

· Regular and reliable attendance.

Competencies

Technical Skills

· Knowledge of TRICARE programs and benefits, managed care concepts, and URAC DM program standards; case management interventions, crisis intervention strategies, collaboration skills, legal and regulatory requirements, and HIPAA privacy regulations.

· Thorough knowledge of Case Management, Utilization Management, HIPAA Privacy and Security regulations.

Team building / Team Player

· Influence the actions and opinions of others in a positive direction and build group commitment.

Problem Solving / Analysis

· Ability to solve problems through systematic analysis of processes with sound judgment; has a realistic understanding of relevant issues.

Organizational Skills

· Ability to organize people or tasks, adjust to priorities, learn systems, within time constraints and with available resources, detail oriented.

Multi-Tasking / Time Management

· Prioritize and manage actions to meet changing deadlines and requirements within a high volume, high stress environment.

Independent Thinking / Self-Initiative

· Critical thinkers with ability to focus on things which matter most to achieving outcomes; commitment to task to produce outcomes without direction and to find necessary resources.

Empathy / Customer Service

· Customer-focused behavior; helping approach, including listening skills, patience, respect, and empathy for another's position

Coping / Flexibility

· Resiliency in adapting to a variety of situations and individuals while maintaining a sense of purpose and mature problem-solving approach is required.

Computer Literacy

· Ability to function in a multi-system Microsoft environment using Word, Outlook, Intranet, the Internet, and department software applications.

Communication / People Skills

· Ability to influence or persuade others under positive or negative circumstances; adapt to different styles; listen critically; collaborate.