Job#: 2068144

Job Description:

Job Title: Outpatient Case Manager

Additional Notes :

• Driving to meet with members in the home, clinic, or community setting.
• Occasionally needs to be able to pick up 25 lbs
  
  

Job Description:

• The Case Manager Outpatient RN is responsible for the assessment, treatment planning, intervention, monitoring, evaluation and documentation on identified High Risk members.
• The Case Manager Outpatient RN will assess and develop a care plan in collaboration with the admitting, attending and consulting physician, the member and other health care practitioners.
• The goal of the Case Manager Outpatient RN is to effectively manage members on an outpatient basis to assure the appropriate level-of-care is provided, to prevent in patient admission and re-admissions, and ensure that the members’ medical, environmental, and psychosocial needs are met over the continuum of care.
  
  

Responsibilities:

• Performs assessment of members’ clinical needs and facilitates care management through care coordination, clinical support, linkages to appropriate resources and other case management functions, as appropriate.
• Develops an outcome-based plan of care, based on the member’s input and assessed member needs. Implements and evaluates the plan of care as often as needed as evidenced by documentation in the member’s case file.
• Manages transition of care from the sending to receiving settings ensuring that the Plan of Care moves with the member and updates/modifies the care plan as the member’s health care status changes.
• Documents member assessment and reassessment, member care plans, and other pertinent information completed in the member’s medical record in accordance with the FOCUS Charting methodology, nursing standards, and company policies and procedures.
• Conducts community visits (hospital, home visits) as needed to assess patient progress, support care management and meet with appropriate members of the patient care team.
• Identifies and addresses psychosocial needs of the members and family and facilitates consultations with Social Worker, as necessary.
• Identifies and addresses pharmacological needs of the members and facilitates consultations with the pharmacy department, as necessary.
• Identifies planned and unplanned transitions of care from Requests for Services or daily inpatient and SNF census.
• Educates the member/caregiver on the transition process and how to reduce unplanned transitions of care.
• Identifies community resources to address needs not covered by the member’s benefit plan, and coordinates member benefits as needed, with the health plan.
• Identifies the appropriate members to participate in the interdisciplinary case round process. Prepares the necessary summary information to present to the team.
• Responsible for the coordination of clinic appointments, medication reconciliation, PCP and SPC visits.
• Responsible for the coordination and facilitation of member and family conferences as determined by assessment of member’s needs.
• Collaborate and communicate with all members of the healthcare team (concurrent review, pre-authorization, PCP/SPC, Social Services, and Pharmacy) to coordinate the continuum of care of developing plans for management of each case.
• Communicates appropriately and clearly with physicians, inpatient case managers and prior-authorization nurses. Interacts professionally with member/family/physicians and involves member/family/physicians in formation of the plan of care.
• Keeps member/family members or other customers informed and requests if necessary, further assistance when needed.
• Demonstrates the ability to follow through with requests, sharing of critical information, and getting back to individuals in a timely manner.
• Participates in the efficient, effective and responsible use of resources such as medical supplies and equipment.
• Other duties as assigned by management.
  
  

EEO Employer

Apex Systems is an equal opportunity employer. We do not discriminate or allow discrimination on the basis of race, color, religion, creed, sex (including pregnancy, childbirth, breastfeeding, or related medical conditions), age, sexual orientation, gender identity, national origin, ancestry, citizenship, genetic information, registered domestic partner status, marital status, disability, status as a crime victim, protected veteran status, political affiliation, union membership, or any other characteristic protected by law. Apex will consider qualified applicants with criminal histories in a manner consistent with the requirements of applicable law. If you have visited our website in search of information on employment opportunities or to apply for a position, and you require an accommodation in using our website for a search or application, please contact our Employee Services Department at [email protected] or 844-463-6178 .

Apex Systems is a world-class IT services company that serves thousands of clients across the globe. When you join Apex, you become part of a team that values innovation, collaboration, and continuous learning. We offer quality career resources, training, certifications, development opportunities, and a comprehensive benefits package. Our commitment to excellence is reflected in many awards, including ClearlyRated's Best of Staffing® in Talent Satisfaction in the United States and Great Place to Work® in the United Kingdom and Mexico.

Apex Benefits Overview: Apex offers a range of supplemental benefits, including medical, dental, vision, life, disability, and other insurance plans that offer an optional layer of financial protection. We offer an ESPP (employee stock purchase program) and a 401K program which allows you to contribute typically within 30 days of starting, with a company match after 12 months of tenure. Apex also offers a HSA (Health Savings Account on the HDHP plan), a SupportLinc Employee Assistance Program (EAP) with up to 8 free counseling sessions, a corporate discount savings program and other discounts. In terms of professional development, Apex hosts an on-demand training program, provides access to certification prep and a library of technical and leadership courses/books/seminars once you have 6+ months of tenure, and certification discounts and other perks to associations that include CompTIA and IIBA. Apex has a dedicated customer service team for our Consultants that can address questions around benefits and other resources, as well as a certified Career Coach. You can access a full list of our benefits, programs, support teams and resources within our ‘Welcome Packet’ as well, which an Apex team member can provide.

Apex Systems is a world-class IT services company that serves thousands of clients across the globe. When you join Apex, you become part of a team that values innovation, collaboration, and continuous learning. We offer quality career resources, training, certifications, development opportunities, and a comprehensive benefits package. Our commitment to excellence is reflected in many awards, including ClearlyRated's Best of Staffing® in Talent Satisfaction in the United States and Great Place to Work® in the United Kingdom and Mexico.

Apex Benefits Overview: Apex offers a range of supplemental benefits, including medical, dental, vision, life, disability, and other insurance plans that offer an optional layer of financial protection. We offer an ESPP (employee stock purchase program) and a 401K program which allows you to contribute typically within 30 days of starting, with a company match after 12 months of tenure. Apex also offers a HSA (Health Savings Account on the HDHP plan), a SupportLinc Employee Assistance Program (EAP) with up to 8 free counseling sessions, a corporate discount savings program and other discounts. In terms of professional development, Apex hosts an on-demand training program, provides access to certification prep and a library of technical and leadership courses/books/seminars once you have 6+ months of tenure, and certification discounts and other perks to associations that include CompTIA and IIBA. Apex has a dedicated customer service team for our Consultants that can address questions around benefits and other resources, as well as a certified Career Coach. You can access a full list of our benefits, programs, support teams and resources within our ‘Welcome Packet’ as well, which an Apex team member can provide.

Apex Systems is part of the Commercial Segment of ASGN Incorporated.

NYSE: ASGN

4400 Cox Road

Suite 200

Glen Allen, Virginia 23060

Apex Systems is an equal opportunity employer. We do not discriminate or allow discrimination on the basis of race, color, religion, creed, sex (including pregnancy, childbirth, breastfeeding, or related medical conditions), age, sexual orientation, gender identity, national origin, ancestry, citizenship, genetic information, registered domestic partner status, marital status, disability, status as a crime victim, protected veteran status, political affiliation, union membership, or any other characteristic protected by law. Apex will consider qualified applicants with criminal histories in a manner consistent with the requirements of applicable law. If you have visited our website in search of information on employment opportunities or to apply for a position, and you require an accommodation in using our website for a search or application, please contact our Employee Services Department at [email protected] (Do not submit resumes or solicit consultants to this email address). UnitedHealthcare creates and publishes the Transparency in Coverage Machine-Readable Files on behalf of Apex Systems.