Case Manager RN - Utilization Management

Job Description

The Case Manager PACE Works collaboratively with all members of the health care team and the participant / family to ensure coordination of participant care and resource utilization. The Case Manager participates in the assessment of participants including physical and psychological factors in order to plan for individualized continuum of care needs and ensures the implementation of the care plan. Provide direct and indirect nursing care to assigned patients. Works under the direct and indirect supervision of the Center Manager or designee but is independent in the application of advanced nursing knowledge and skills. Manages complex clinical situations for which he / she is responsible.

Responsibilities

Care Management

• Care provided conforms to accepted practice standards; provides correct treatments / procedures and other care as prescribed and according to participant care standards; demonstrates understanding of age-related characteristics and needs of participants served.
• Explains nursing procedures in appropriate forms; identifies emergency situations and independently initiates advanced therapy; acts as coordinator of participant care with other health care personnel and evaluates participant care measures instituted; understands and demonstrates respect for participant rights and utilizes established mechanisms for management of ethical issues in participant care.
• Responsible for the oversight of all care components of each Participant assigned. Coordinates the care of the Participant. Responsible for follow-up of acute illnesses and problems. Has knowledge of the Participant's on-going status at all times.
• Responsible for appointment and referral scheduling, chart management.

Assessments

Leadership

Clinical Skills

Interdisciplinary Team

Qualifications

Experience : Experience with the frail / elderly in accordance with CMS regulations for PACE programs.

Education : Graduate of accredited school of nursing

Training : Possess knowledge and skills necessary to treat geriatrics participants

Special Skills : IV expertise and ability to multi-task and triage clinical situations. Must have in-depth assessment skills for the geriatric population.

Licensure : Current Louisiana State license as RN; BLS