VNA Health Care - Aurora, Illinois
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Managed Care Specialist, RN
Job Code:05172017-121
Location:0-None
FT/PT Status:Regular Full Time
  

Description:

A registered professional nurse who is responsible for coordinating clinic and patient care through the facilitation of access to MCO plans.  Will work in collaboration with VNA Providers, health center staff, third party payers, community and government based organizations to meet and exceed mutual patient care outcome goals and needs. 


Primary Functions:
  1. Understands and accepts responsibility for all professional care duties performed. Follows accepted standards of nursing practice. Provides care coordination and case management for all patients served by the department, as assigned.

  2. Coordinates patient care and communication among VNA primary care provider, other VNA services, other specialty services, community resources and volunteer based organizations.  Communicates with these members on a regular basis for progress reports.

  3. Main VNA point of contact for all Insurance companies.

  4. Assesses patient’s needs, develops and coordinates an individualized plan of care, including involving the client/family in the development of the patient’s goals and collaboration with other health care professionals as necessary.

  5. Makes regular telephone contact with patients and payer sources to provide follow-up and/or assists with further care.

  6. Identifies high and moderate risk patients through clinic risk identification tools.

  7. Monitors and/or prepares data/reports.

  8. Works effectively with VNA staff and outside agencies to assist in developing reports and execute patient care coordination and positive population health outcomes.

  9. Handles complex case management of patients and ensures care continuity through all sites of health care services - clinic, Emergency room, inpatient and home based services.

  10. Completes timely, current and accurate documentation for all patient care activities. Follows organization documentation guidelines including electronic and paper processes.

  11. Assumes responsibility for own professional development. Participates in continuing education programs and in-service programs. Completes continuing education as indicated by organization accreditation requirements.

  12. Follows infection control and infection prevention per protocol.

  13. Demonstrates sound judgment in decision-making.

  14. Recognizes own behavior patterns, stresses and attitudes which impact client care. Explores methods of dealing appropriately with emotional strain


Qualifications
  1. BSN preferred. Current Registered Nurse License in the State of Illinois under the Illinois Nursing Act.
  2. Experience: Two or more years of generalized nursing experience preferred, preferably within a managed care organization (MCO setting).
  3. Experience with care coordination and insurance case management.
  4. Knowledge and Ability: Comprehensive knowledge and skill in current nursing practice; concept of multidisciplinary team approach to nursing care; knowledge of professional limitation and scope of practice within the Illinois Nursing Act.
  5. High degree of sensitivity to the rehabilitation needs of patients and their families and the ability to establish constructive working relationships with them.
  6. Maintains current CPR certification.
  7. Owns and operates a car.
  8. Maintains current driver's license and car insurance.
  9. Computer skills required.

Essential Functions/Physical Requirements:
1. Ability to perform tasks involving physical activity which includes heavy lifting and extensive bending and standing.
2. Ability to communicate effectively verbally and in writing.
3. Tactile, visual, auditory and olfactory senses intact.
4. Ability to climb stairs and ambulate in and out of patient's homes in all weather.
5. Ability to drive a car.
6. Manual dexterity sufficient to perform nursing procedures.
7. Ability to deal effectively with high levels of stress.
8. Ability to wear a particulate respirator during patient care as necessary.
  

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