GENERAL DESCRIPTION
The Nurse Case Manager assists the Regional Director of Nursing in implementing and maintaining the patient management program, the quality management, quality assurance and quality control program and quality improvement activities; the regulatory compliance program by ensuring compliance with ACHC and URAC standards, federal and state laws and regulations (including HIPAA). Risk management, safety, security, infection control, other responsibilities include the completion and a care plans and patient assessment or re-assessment, audit of patient management program records; staff training and in-service; and collaborating with home health agencies. This position is remote, but may be required to work on-site at a BioMatrix location, as needed.
QUALIFICATION REQUIREMENTS
- Bachelor’s Degree in Nursing preferred, but not required
- Valid Nursing license in good standing
- 3 – 5 years related work experience in patient care
- Basic level computer and internet skills (e.g. Microsoft Office, etc).
- Willing to travel for business purposes (when necessary to attend meetings, conferences, seminars, etc.)
QUALIFICATIONS PREFERRED
- Master’s Degree in Nursing preferred, but not required.
- Regulatory compliance and/or quality management background preferred, but not required.
- Knowledge of pharmacy software a plus.
ESSENTIAL FUNCTIONS AND RESPONSIBILITIES
- Assists Regional DON in maintaining a timely patient management program (PMP); obtains patient demographic and clinical information; completes the initial patient assessment, care plans and engages the patients in the PMP; and completes the patient re-assessment under the supervision of the Corporate Director of Nursing.
- Assists intake and pharmacy staff in searching and coordinating with home health nursing agencies in the care of MHG patients if applicable. Also provides training for nurses contracted by home health nursing agencies.
- Participates in QM Committee (QMC): prepares the QM agenda and supporting documents; and creates meeting minutes.
- Completes audits and inspections, documents the data collection, aggregates and analyzes the data, and provides written reports with appropriate graphics for clients and ACHC and URAC accreditation.
- Reports to leadership and committees on quality management and improvement activities, and creates corrective action plans as needed under the direction of the pharmacists and the QMC.
- Participates in pharmacy department management, QA and Clinical Oversight Body (COB) meetings; with a focus on quality and safety. Takes meeting minutes.
- Assesses published literature to identify treatment, safety and educational best practices and evidence based guidelines.
- Establishes a working knowledge and is up-to-date on ACHC and URAC Core and Specialty Pharmacy accreditation standards.
- Assists pharmacists with BioMatrix regulatory compliance program including the implementation of tracking systems and audits to ensure compliance with federal, state and pharmacy regulatory standards including HIPAA, and health and safety codes (i.e. risk management, medication – use safety, fire safety and infection control).
- Maintains a working knowledge and is up-to-date on federal, state and pharmacy laws and regulations as applied to operations.
- Provides HIPAA compliance and Medicare’s Fraud, Waste, and Abuse training to employees, annually and ongoing as needed.
- Maintains patient confidentiality in remote work environment as per HIPAA Privacy Rule standards.
NON-ESSENTIAL FUNCTIONS & RESPONSIBILITIES
- Participation in membership in professional societies and organizations.
- Ability to prioritize and handle multiple tasks and projects concurrently.
- Careful attention to detail.
- Performs related duties as requested.
- Participates in quality assurance activities and audits as directed.
KNOWLEDEGE, SKILLS AND ABILITIES REQUIREMENTS
- Able to function independently under remote supervision
- Excellent written and verbal skills
- Attention to detail and high level of accuracy in work
- Excellent patient engagement and clinical assessment skills
- Demonstrates sound judgement consistent with evidence based medicine
- Demonstrates critical thinking and excellent problem solving
Communication Skills
- Oral Communication – Speaks clearly and persuasively in positive or negative situations; listens and gets clarification; Responds well to questions; Demonstrates group presentation skills; Participates in meetings.
- Written Communication – Writes clearly and informatively; Edits work for spelling and grammar; Varies writing style to meet needs; Presents numerical data effectively; Able to read and interpret written information.
Computer Skills
- Become and remain proficient is all programs necessary for execution of position.
PHYSICAL DEMANDS AND WORK ENVIRONMENT
- This position requires constant sitting with occasional walking, standing, kneeling or stooping.
- This position requires the use of hands to finger, handle or feel objects and the ability to reach with hands and arms.
- This position requires constant talking and hearing.
- Specific vision abilities required by this job include close vision and the ability to adjust focus.
- This position must occasionally lift and/or move up to 20 pounds
- Required to move/lift physical hardware.
AMERICANS WITH DISABILITY SPECIFICATIONS
PHYSICAL DEMANDS
The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
While performing the duties of this job, the employee is occasionally required to stand; walk; sit; use hands to finger, handle, or feel objects, tools or controls; reach with hands and arms; climb stairs; balance; stoop, kneel, crouch or crawl; talk or hear; taste or smell. The employee must occasionally lift and/or move up to 25 pounds. Specific vision abilities required by the job include close vision, distance vision, color vision, peripheral vision, depth perception, and the ability to adjust focus.
OTHER
- Will participate in legal and ethical compliance training each year.
- Will consistently behave in compliance with the BioMatrix, LLC’s legal and ethical policies and
- procedures.
- Will abide by the policies of BioMatrix, LLC as set forth in the Compliance Manual.
- Will not participate in any conduct considered to be unethical or illegal.
EXPECTATION FOR ALL EMPLOYEES
Supports the organization’s mission, vision, and core values by exhibiting the following behaviors:
Patient’s First; All In (Stacked Hands); RCM (Relentless Consistency Wins).
GENERAL INFORMATION:
The above statements are intended to describe the general nature and level of work being performed by individuals assigned to this position. They are not intended to be an exhaustive list of all duties, responsibilities, and skills required of personnel so classified.
The incumbent must be able to work in a fast-paced environment with demonstrated ability to juggle and prioritize multiple, competing tasks and demands and to seek supervisory assistance as appropriate.
Incumbents within this position may be required to assist or find appropriate assistance to make accommodations for disabled individuals in order to ensure access to the organization’s services (may include: visitors, patients, employees, or others).