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Nurse Case Manager

Company: The Orthopedic Clinic of Daytona Beach
Location: Daytona Beach
Posted on: September 12, 2018

Job Description:

Description: The Orthopedic Clinic is seeking a highly motivated case manager to work as part of a multidisciplinary team, serving the Medicare orthopedic population. The case manager will provide telephonic case management/care coordination to Medicare members enrolled in the Bundled Payment Care Initiative. The Orthopedic Clinic strives to work collaboratively with our patients, providers and care givers to ensure a positive outcome, throughout the continuum of care.The Case Manager will utilize the nursing process to provide optimal quality and continuity of nursing care from the pre-operative setting through a 90 day episode of care. The Case Manager will implement care plans that are specific to each patients physical, mental and social needs, based on pre-surgical clinical assessments. The care plans will be implemented and modified, as needed throughout the transition of care to ensure the patients well-being and achievement of the desired outcomes. The Case Manager will work collaboratively as part of a multi-disciplinary team to provide patient and family education, communicate with healthcare providers and coordination and facilitation of services within an episode of care.. Requirements: --- Responsible for managing a group of Medicare orthopedic population throughout a ninety-day episode of care, as part of the Bundled Payments for Care Improvement-Advanced Initiative. --- Gather clinical information from the EMR and telephonic health assessments to determine risk stratification (This includes a comprehensive assessment of physical, emotional, psychosocial, and environmental needs of the patient). --- Document clinical assessments and care plans in designated case management system --- Educate the patient and caregiver of the process and expectations of the health care delivery system throughout the course of care, AR, SNF, LTAC, Home Care --- Collaborate with multidisciplinary team members in the acute, post-acute and outpatient settings to identify patient needs such as home health care, DME, physical therapy and community services --- Follow up on patients at pre-determined intervals and as needed based on patient status, telephonic and on-site --- Complete and submit all required documentation within established guidelines --- Evaluate plan of care and revise on ongoing basis as determined by patient's health status and communicate changes to all other disciplines involved in the patient's care --- Identify gaps or barriers in treatment plans to ensure that discharged patients receive appropriate resources and services --- Understand the Bundled Payment Program design, implementation, management, monitoring and reporting requirements --- Adhere to the scope of practice for the Registered Professional Nurse per state regulatory guidelines --- Maintain confidentiality of all patient information per HIPAA and Signature Care Management guidelines --- Perform other duties as assigned --- Current unrestricted Florida RN license --- Minimum of 2-3 years nursing experience in a hospital setting or telephonic case management experience required --- Preferred candidate are BSN certified case managers or have experience with discharge planning and outpatient care coordination --- Medicare or Medicare Advantage experience preferred --- Orthopedic and Geriatric experience a plus --- Computer Literate - Windows environment, EHR, athenanet helpful--- Ability to clearly communicate written and verbal instructions--- Clean Driving Record--- Proof of auto insurancePM18

Keywords: The Orthopedic Clinic of Daytona Beach, Daytona Beach, Nurse Case Manager, Executive, Daytona Beach, Florida

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