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Program RN Case Manager - Job Description - 10.2024","","RN Case Manager role description for providing case management services to TRICARE beneficiaries. The position covers referral screening, comprehensive assessment, development and implementation of an individualized care plan, ongoing monitoring for effectiveness, and monthly reassessments. 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Program RN Case Manager – Job Description  \nWhite Stone Healthcare Resources is an Equal Opportunity Employer and an E-Verify participant that recruits and hires qualified applicants without regard to race, color, religion, sex, sexual orientation, gender identity, age, national origin, ancestry, citizenship, disability, or veteran status.  \nJOB SUMMARY  \nThe position provides Case Management services for TRICARE beneficiaries. The Case Manager RN is responsible for screening referrals for Case Management and performing a comprehensive assessment. The CM RN develops and implements an individualized Care Plan and is responsible for monitoring for effectiveness and desired outcomes. Reviews and performs reassessments as needed to ensure identified needs are addressed. CM RN is responsible for reviewing and processing authorization and referral requests according to policy. Case Manager RNs are responsible for reviewing and being knowledgeable regarding the scope of practice of their state of licensure.  \nQUALIFICATIONS  \nRequired  \n• U.S. citizenship  \n• Current unencumbered state license as a Registered Nurse  \n• Two years full-time equivalent of direct clinical care to the consumer  \n• Ability to obtain a URAC-recognized certification in case management within three (3) years of hire  \n• Highly reliable; strong work ethic  \nPreferred  \n• 2 years case management experience  \n• URAC-recognized case manager certification  \nKEY RESPONSIBILITIES  \n• Applies knowledge of HIPAA privacy and security regulations as well as URAC accreditation standards to ensure compliance in daily practice.  \n• Screens beneficiary needs and circumstances with predetermined program criteria to determine appropriateness for case management. Identifies beneficiaries at high-risk for significant adverse health outcomes and with high-cost, clinical and psychological factors impacting care.  \n• Documents the process by providing the case management enrollment information and acceptance letter to the beneficiary. Provides timely decision of acceptance into the case management program and completes appropriate notifications.  \n• Completes comprehensive case management assessments. Develops individualized case management care plans to assist beneficiaries with obtaining access to quality care in a costeffective manner. Obtains necessary agreements for obtaining protected health information as needed. Makes the care plan available to the Primary Care Manager or Behavioral Health provider for information and input.  \n• Reassesses and monitors care plans for adjustments on a monthly basis, at a minimum, to address newly-identified needs, services, treatment, and funding options. Documents changes in the care plan maintained in the medical management system.  \n• Evaluates case management outcomes, assessing the individual beneficiary's satisfaction and compliance with the care plan.  \n• Prepares and presents cases involving high-profile or sensitive issues to the Medical Director for review.  \n• Functions as an advocate for the beneficiary by ensuring access to necessary care and maintaining beneficiary’s safety, locating specialized services outside the network by identifying providers, exploring nature of services offered, and facilitating process.  \n• Supports beneficiaries by providing TRICARE and community resource information and internal care referrals as needed to meet care plan goals.  \n• Understands, administers the TRICARE Specialty Program benefits, including program registration, enrollment, authorizations, and screening for high risk factors indicating appropriateness for catastrophic case management services.  \n• Monitors and provides direction to non-clinical staff.  \n• Regular and reliable attendance is required.  \nCOMPETENCIES  \nTechnical Skills  \nThorough knowledge of Case Management, Utilization Management, TRICARE policies and procedures, HIPAA Privacy and Security regulations, URAC accreditation standards, Managed Care concepts, B","cbCaifWxMU3YHPOM","https://ap.wps.com/l/cbCaifWxMU3YHPOM","pdf",319620,"English","# Job Summary\n## Qualifications\n## Key Responsibilities\n## Competencies\n### Technical Skills\n### Team-Building / Team Player\n### Problem Solving / Analysis\n### Organizational Skills\n### Multi-Tasking / Time Management\n### Independent Thinking / Self-Initiative\n### Empathy / Customer Service\n### Coping / Flexibility\n### Computer Literacy\n### Communication / People Skills","[{\"question\":\"What is the primary purpose of the RN Case Manager position?\",\"answer\":\"The RN provides case management services for TRICARE beneficiaries, including screening referrals, conducting assessments, and managing individualized care plans.\"},{\"question\":\"Which compliance and accreditation requirements must the CM RN follow?\",\"answer\":\"The role requires applying HIPAA privacy and security regulations and URAC accreditation standards to ensure daily-practice compliance.\"},{\"question\":\"What are the key responsibilities related to care planning and review?\",\"answer\":\"The CM RN develops and implements an individualized care plan, makes it available for provider input, monitors effectiveness, and completes reassessments at least monthly to address newly identified needs.\"}]","Medical Mgt. Program RN Case Manager - Job Description - 10.2024 | PDF",1789361699]