The RN Case Manager provides daily care coordination, case management, coaching, consultation and intervention to patients with one or more chronic diseases. The RN Case Manager is responsible for identifying said population via provider/clinic referral, utilization management referral, disease registry reporting mechanisms and patient self-referral. This position will also provide case management to patients who are admitted to the hospital and those patients who may need to be enrolled in ambulatory case management. Works as part of an interdisciplinary care team coordinating social work and mental health counseling, psycho-social support services, in-home support, legal services, skilled nursing, home health, etc. The RN Case Manager effectively collaborates with members of the interdisciplinary care team and with the physician in the clinic. The RN Case Manager performs telephonic face to face assessments on assigned patients. The RN Case Manager serves as the leader of a cohort of LVN Case Managers, Case Manager Coordinators, and Social Workers providing Case Management to a specified population of patients. RN Case manager provides support and guidance to said cohort.
I. MEETS PERFORMANCE REQUIREMENTS
II. EXCEEDS PERFORMANCE REQUIREMENTS
All items listed under "Meets Expectations", and: