RN Case Manager - Northwest Region - Evernorth Care Group

Summary

The Nurse Case Management Lead Analyst is an integral member of the Care Management department as part of Evernorth Care Group (ENCG) primary care team.

This role is aligned to and supports ENCG Healthcare Centers and clinicians to improve the health of the patients we serve, with a focus on the management of high- and rising-risk, disease burdened members.

The Nurse Case Management Lead Analyst utilizes clinical skills to assess, plan, implement, coordinate, monitor and evaluate options and services in order to facilitate appropriate healthcare outcomes for members.

The Nurse Case Management Lead Analyst ensures that program objectives are met and supports patients and clinician practices in coordinating patient care through transitions, barriers to care, and education.

This role additionally connects patients to programs and services as available through ENCG, Health Plan benefits, and within the community.

This position manages a panel of patients coordinating services with them.

This role provides disease management and ongoing follow-up of members with Congestive Heart Failure (CHF), Diabetes Mellitus (DM), Chronic Obstructive Pulmonary Disease (COPD) and other conditions based on patient need.

Reports to : Clinical/Operational Supervisor

Hybrid position:

Direct Reports : No direct reports, but does provide clinical support and oversight to non-clinical staff.

Clinical Responsibilities and Essential Functions

Care Coordination: Coordinates the care of the high-risk, post transition and targeted populations in appropriate, efficient and cost-effective manner.

Assists patient to arrange timely access to services, evaluates social/financial/environmental support adequacy in a culturally sensitive manner.

Care Planning: Collaboratively creates/updates care plans for care transitions, disease management, and other as needed.

Evaluates the effectiveness/relevance of the treatment plan and communicates with the primary care provider and health care delivery team.

Seeks input from health care team members and clinicians as able in order to update care plan.

Prepares for and participates in care team huddles/meetings to problem solve around highly complex care needs.

Disease Management/Outreach: Initiate new customer and ongoing telephonic connections per protocol for an identified caseload.

Build care relationships among patients/caregivers.

Completes post-discharge calls to all identified patients to facilitate and oversee discharge planning "coordination of care" needs, identifying and closing gaps in care, and providing education within specified timeframes.

Use of Internal/External Resources: Identifies and refers appropriate patients to eligible programs within ENCG and respective Arizona health plans.

Review and inform the patient/caregiver around options for care, use of benefits and community resources.

Act as the community resource expert for patients/practices for high-risk members, including transition of care/hospice...