Rutgers, The State University of New Jersey, is seeking a Care Coordination Manager for the Environmental and Occupational Health Sciences Institute (EOHSI). 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. The Care Coordination Manager performs case management and associated administrative and QA responsibilities in compliance with the contractual requirements of a federal health program.
Oversees the staff and day-to-day operations of the nurse case management team.
Establishes a professional and strong working relationship with physician, nursing, mental health, and operations teams; government officials, and 3rd party administrators to coordinate patient care and to ensure optimal patient outcomes. Ensures that each clinical core understands the involvement of the Case Management Team and is responsive to problems related to clinical outcomes, documentation, cost per case, etc. within best practice, ethical, legal and regulatory parameters.
Implements process and systems improvements to enhance department operations. Develops strategies to affect clinical outcomes for patient population including the development of structured care methodologies.
Adapts best practice findings and research in tangible ways to the clinical setting. Works to break down barriers to evidence based culturally competent care.
Builds community and organizational relationships that enhance the care coordination functions.
Oversees departmental QA. Uses electronic databases to perform QA required by Program Administrator and NIOSH and to identify areas for improvement, including but not limited to determining clinical outcomes of department, analyzing clinical performance of case management team members, and comparing clinical service outcomes to standards of care.
Carries caseload of case management patients. Facilitates the development and implementation of a comprehensive, multidisciplinary plan of care for patients with complex medical, nursing and/or personal care needs, to enable their return to an optimal level of functioning.
Follows up with patients, with certified conditions covered in the federal health program, to identify needed services and coordinate care accordingly. Ensures referrals are coordinated and service summary reports are maintained in the electronic health record (EHR) system.
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.
Minimum Education and Experience:
Registered Nurse with a license to practice in the State of New Jersey plus a minimum of five (5) years' experience in case management.
Bachelor's Degree in Nursing or a health care related field.
National certification in case management and at least two (2) years of case management experience.
Required Knowledge, Skills, and Abilities:
Excellent interpersonal, communication skills.
Must demonstrate a strong orientation to customer satisfaction, effective teamwork, problem solving and conflict management and resolution.
Knowledge of EMR (Electronic Medical Records).
Must be proficient in MS Office Word, Access, Excel software and Microsoft Outlook.
Oncology nurse experience
Physical Demands and Work Environment:
PHYSICALDEMANDS: Standing, sitting at computer for a length of time, walking, talking and hearing. No special vision requirements. Lifting up to 25 lbs.
WORKENVIRONMENT: Clinical Office; moderate noise.
Posting Number: 18ST2287
Location: Piscataway (RBHS)
Internal Number: 70847
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.