Registered Nurse Case Manager, Harrisburg Pa

Location of Position: Bureau of Fee-for-Service Programs Description of Work/Duties: 1. Consultant in this position will serve as a Clinical Management Consultant for the Department of Human Services, Office of Medical Assistance Programs; 2. Be available as a full-time consultant, approximately 37.5 hrs per week; 3. Possess an active Pennsylvania Registered Nurse license; 4. CCM (Certified Case Manager) required-, administered through CCMC (Commission or Case Management Certification) or the National Academy of Certified Care Managers or American Nurses Credentialing Center; or attain certification after 12 months of continuous employment from the date of hire. Continued employment would be conditional on the candidate obtaining certification within the said time; 5. Possess a documented work history of two or more years of experience in case management or a related field; 6. Possess basic computer skills, including familiarity with Microsoft Office programs; 7. Case manager will perform the six (6) essential activities of case management: assessment, planning, implementation, coordination, monitoring, and evaluation; 8. Follow the Standards of Practice for Case Management as established by the Case Management Society of America (CMSA). Principal Duties and Responsibilities: 1. Assess the need for case management intervention by obtaining and objectively evaluating data, including clinical information, medical history, level and location of care, functional status, psychosocial and environmental factors; 2. Document assessment, plan of care and timetable for implementing interventions; 3. Facilitate the implementation of the care plan by optimizing available benefit, comparing the benefits and cost of care; 4. Plan alternatives based on recipient needs and investigate opportunities to use available community resources and educates the recipient, family or significant other, physician and providers relating to the availability of community resources and services; 5. Utilize Medical Assistance regulations for prospective review of medically necessary services and procedures; 6. Work closely with the PCP, specialists and other providers to support the treatment plan and achievement of goals developed for and by the recipient or caregiver; 7. Set expectations for timely reports within the vendors providing services; 8. Measure effectiveness, necessity and efficiency of the care plan and make revisions as needed; 9. Collaborate with enrolled providers to assure recipients are referred to the appropriate providers to deliver care and services to recipients in a cost-effective manner; 10. Work closely with medical directors to implement appropriate action plans; 11. Provide clinical evaluation of Age Out cases; 12. Collaborate with the inpatient review nurses to coordinate discharge planning to an appropriate level of care; 13. Effectively manage a caseload of up to 75 - 100 cases; 14. Maintain management records in accordance with professionally accepted standards; 15. Participate in the development of desktop procedures; 16. Collaborate with other bureaus/contractors to assure continuity of care; 17. Perform other duties as assigned by the Bureau Director or medical directors. 18. Consultant will report to the Division Director and/or division supervisor. Assignments will be received verbally or in writing and will be carried out independently with minimal direct supervision. 19. Consultant, when requested, will work at one or more of the Department's work sites. Consultant's primary work location will be in Harrisburg, PA. Consultant will be provided with a desk, computer, phone, and all items necessary for him/her to complete assignments.