Care Manager

Job Summary

The Assessment Team Clinical Nurse Reviewer is responsible for the timely and accurate review of completed cognitive and functional assessments conducted for Long-Term Care Insurance policyholders. Interacting with assessors, the Clinical Nurse Reviewer obtains necessary clarifications to documentation submitted, provide training to assessors who are new or need retraining on completing assessments and conducts telephonic assessments with other health care providers when an assessment/reassessment is needed for a claimant residing in a long-term care facility. The Clinical Nurse Reviewer responds to clinical questions from long term care insurers and provides input on the quality of assessors upon completing their review.

Duties/Responsibilities:

• Follow up with nurse assessors to valid responses on completed assessments.
• Demonstrates the use of interviewing skills that include the professional judgment to probe as necessary to uncover underlying concerns of the client.
• Assess patient specific information related to level of function and individual needs.
• Develop Plans of Care (POCs) and Chronically Illness Certifications (CICs).
• Establishes and maintains empathetic working relationship with clients.
• Understands average benchmark for duration of services for disease treatment.
• Considers and applies principles of human behavior, family/caregiver dynamics, human development and disability into the care management process.
• Demonstrates the use of interviewing skills that include the professional judgment to probe as necessary to uncover underlying concerns of the client.
• Assesses clinical evaluations and coordinates all aspects of treatment options to meet goals.
• Continuously monitors status and impact of care management and adjusts plan accordingly.
• Evaluates the client needs for medically necessary services at intervals, determines the effectiveness in reaching desired outcomes.
• Assesses and addresses specific disease process issues.
• Complete telephonic assessments of claimants and caregivers, when necessary.
• Other duties and responsibilities may be required.

Required Skills/Abilities:

• Show initiative and sound judgment in performing tasks.
• Typing skills 45 wpm
• Knowledge of Windows, Microsoft Suite
• Exhibit excellent customer service skills.
• Work on multiple tasks at any one time while maintaining high quality standards.
• Must be process-oriented with sound judgement, attention to detail, accuracy, and follow-through including the flexibility to perform in an ever-changing work environment.

Education and Experience:

• High school diploma or GED
• Active and unrestricted RN license in good standing. A contact license is preferred.
• Two years’ experience in geriatric care