RN Case Manager - United States Air Force Academy

SUMMARY: Performs healthcare coordination and case management activities IAW Medical Treatment Facility (MTF) instructions.

ESSENTIAL DUTIES & RESPONSIBILITIES:

• Ensures compliance with standards of care and practice (Accreditation Association for Joint Commission on Accreditation of Healthcare Organizations (JCAHO), Ambulatory Health Care (AAAHC) & Case Management Society of America (CMSA)). • Collaborates with military and civilian healthcare providers and staff and uses Utilization Management (UM) systems support to identify high-risk/high-cost patients within MTF population. • Determines eligibility for healthcare coordination/case management services. • Coordinates with healthcare providers to ensure appropriate appointment alternatives, access and quality of care. • Coordinates services for eligible patients based on subjective and objective assessment data and identified patient/family needs. • Facilitates a multidisciplinary team to develop a treatment plan to address all identified conditions and problems. • Integrates health education, promotion and prevention activities utilizing available MTF and local civilian condition/disease management resources. • Participates in the orientation, training, and evaluation of competency of newly assigned Case Management personnel. • Attends bi-weekly and as-needed multi-disciplinary discharge planning conferences within the MTF and as needed at the local treatment facilities. • Assists TRICARE eligible and Medicare-eligible patients in accessing local TRICARE and Medicare providers in conjunction with the MTF Referral Centers and the Central Referral Center. • Maintains current directories of local Medicare providers, suppliers, and Institutions. • Evaluates case management process utilizing defined parameters such as admissions, length of stay, level of care, Emergency Department/outpatient clinic visits and patient outcomes and institutes appropriate interventions. • Generates and maintains appropriate patient administrative records and provides upon request. • Reports monthly summary of care to Director, Medical Management (MM) or designee. • Conducts monthly evaluation, in conjunction with Primary Care Management (PCM) team, the benefit of case management. • Closes case management cases when maximum patient benefit has been obtained. • Ensures a safe work environment and employee safe work habits. • Maintains regular and punctual attendance. • Performs all other duties as assigned.

SUPERVISORY RESPONSIBILITIES: None.