Nurse Care Manager

General Description

The Nurse Care Manager is responsible, as part of the care team, for the overall patient care management process.  The NCM provides oversight, guidance and support for the patient care plan as developed through Home Based Provider (HBP) evaluation and physical risk assessment; as well as nursing evaluation and risk assessment.  The NCM uses nursing assessment and evaluation skills to help guide treatment and care decisions of the team and also identifies services and vendors for needed care while navigating patient benefit plans.  The NCM represents INSPIRIS in communications with external customers such as health plans, vendors, patients, family, community providers and the media.  The NCM uses nursing decisions to provide support for the care management process.

Organizational Relationships

The NCM reports to the Network Medical Director through a hard line relationship, but also reports to the Network Clinical Operations Manager with a dotted line relationship. The NCM is a member of the Medical Management, Network, PCT and HBP NCM teams.

Specific Duties

• The NCM is first and foremost an advocate for the patient in all activities including nursing assessments, care coordination, care plan development, and communication.
• This position is accountable for identifying and developing innovative actions to meet the needs of INSPIRIS patients from both the health care and psychosocial / socioeconomic dimensions of care as well as taking action for provision of services to meet those needs.
• The NCM utilizes nursing assessment skills and decision making authority to make recommendation and direct patient care to meet the needs of the patient and support the care recommendations of the HBP.
• The NCM, as part of the patient care team, works closely with the HBP to coordinate all needed care and service; as well as ensuring services are completed timely and effectively through oversight of the order process
• The NCM participates in the development of the patient risk management plan and ensures that the identified actions are completed per the plan
• The NCM actively participates in case management conferences
• The NCM will represent INSPIRIS through facilitation of the communication process with external customers such as community physicians, contracted vendors, health plan clients, families, patients, caregivers, the community and the media.
• The NCM will provide support and assistance for patients and families through the development of a bonding telephonic relationship.
• The NCM will be responsible to maintain the documentation of activities within the Medical Record per INSPIRIS policies.
• The NCM will be asked to initiate and maintain the relationship with the patient through enrollment, interview and periodic assessment activities.
• As part of a call schedule, The NCM will provide 24/7 support for HBP sand patients.
• The NCM will develop and complete reports for client level and internal performance level reporting.
• The NCM performs other duties that are consistent with meeting departmental and organizational goals and objectives.

• Active un-encumbered license to practice nursing in the state. 
• A minimum of 2-3 years nursing experience.
• A minimum of 1 year NCM experience with INSPIRIS or 2 years Case Management experience.
• Case Management certification is a plus.
• Must be able to effectively communicate with elderly and chronically ill patients and families using the telephone.
• Demonstrates effective assessment and treatment plan development skills.
• Understanding of Medicare, Medicaid and Health Plan benefit structures beneficial.
• Managed care, utilization management, risk management, quality management, case management experience helpful.
• Basic knowledge of computers and cell phones.
• Familiarity with ICD-9 and CPT-4 coding.
• Bi-lingual or multi-lingual a plus.
• Excellent organizational skills with the ability to multi-task.
• Must have experience working within a team environment.