Rutgers, The State University of New Jersey, is seeking a Staff Nurse (RN Case Manager) for the Clinical Research and Occupational Medicine Division of Environmental and Occupational Health Sciences Institute. In accordance with professional case management standards, skillfully assesses, advocates, plans, implements, coordinates, monitors, and evaluates health care options and services to meet needs of the patient in the medical neighborhood. Performs case management and associated administrative duties in compliance with the contractual requirements of the federal health program.
Among the key duties of this position are the following:
The Staff Nurse/RN Case Manager will participate in a dynamic multidisciplinary team to provide case management services to complex patients by partnering with patients and their families/caregivers, engaging them in the accountability of care, and improving patient experiences and outcomes.
Addresses the medical, nursing and or personal care needs of the patient to enable their return to an optimal level of functioning.
Conducts comprehensive needs and risk assessment of the patient to prioritize care needs and resource allocation.
Reviews programmatic medical claims for clinical appropriateness. Assesses pre- and post- authorization compliance and assists in auditing activities to ensure medical records are complete and in accordance with federal standards.
Identifies support systems that indicate actual or potential problems and sets health care goals based on needs and risk assessment findings and anticipated care barriers.
Re-asseses the member's progress towards identified care goals on regular basis and collaborates with the multidisciplinary health care team to adjust the patient's care plan, as medically appropriate.
Identifies cost-effective resources while providing quality care to reach desired outcomes.
Follows-up with patients when certified of conditions covered under the WTC federal health program to identify and access needed services and coordinate care accordingly.
Develops care plans, collaborates with external agencies, participates in case conferences, provides self-management support and health coaching.
Communicates with the patient's Patient-Centered Medical Home and external providers to ensure patients receive care for conditions not covered under the federal health program.
Collaborates with other members of the health and case management team- including physicians, psychotherapists/psychiatrists, supervisors, health care professionals, administrative staff, government officials, Third Party Administrators, and Human Resources.
Maintains medical records in the EMR and case management databases in accordance with established guidelines.
Participates in quality assessment and improvement activities to promote effective and efficient case management for patients and to support reporting requirements of WTC Program Administrator.
Minimum Education and Experience:
Graduate of an accredited School of Nursing with a license to practice in the State of New Jersey. (Active and in Good Standing).
Two (2) years of clinical experience as a Registered Nurse, one year of Case Management experience required.
Case Management certification or certification eligible required. Certification in Case Management within one year of hire required.
Required Knowledge, Skills, and Abilities:
Proficient in Microsoft Office Word, Microsoft Access, Microsoft Outlook and Microsoft Excel.
Physical Demands and Work Environment:
Sitting at a computer for a length of time.
Must be able to lift or exert force up to 25 lbs
Posting Number: 18ST3320
Location: Piscataway (RBHS)
Internal Number: 77159
About Rutgers University
Rutgers, The State University of New Jersey, is a leading national public research university and the state's preeminent, comprehensive public institution of higher education. Rutgers is dedicated to teaching that meets the highest standards of excellence; to conducting research that breaks new ground; and to turning knowledge into solutions for local, national, and global communities. As it was at our founding in 1766, the heart of our mission is preparing students to become productive members of society and good citizens of the world. Rutgers teaches across the full educational spectrum: preschool to precollege; undergraduate to graduate and postdoctoral; and continuing education for professional and personal advancement. Rutgers is New Jersey's land-grant institution and one of the nation's foremost research universities, and as such, we educate, make discoveries, serve as an engine of economic growth, and generate ideas for improving people's lives.