Smartpo 2008-4-6 19:52
Nurse case Manager
Please send cover letter and resume to [email]smartpo@yahoo.com[/email] if you are interested, with the header to Human Resources (Randy Daigneau).
*** Able to speak Mandarin or Cantonese will be a plus. ***
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Within the framework for the nursing practice, the Nurse Case Manager functions as an integral member of a multidisciplinary Case Management Team.
The Nurse Specialist will actively participate in a co-ordinated approach to Medical Health Care and Financial Arrangements, assuming responsibility for maintaining a high level of service to the client and their customers.
Qualifications
• R.N. Holds a valid certificate of competence from the College of Nurses of their own province, and function within the “Standards of Nursing Practise for Registered Nurses” as set by the College.
• Degree would be an asset
• Excellent written and verbal communication skills
• Skills that will complement the specific products of Active Claims Management Inc.
• Knowledge of Individual Life products and systems
• Knowledge of New Business systems
• Proficient in PC based technologies
• Recent clinical experience and demonstrated clinical competence in emergency medicine, medical surgical and intensive care nursing.
• Leadership and effective communication skills are required.
• Additional language skills and knowledge of the insurance environment is an asset.
Essential Skills
This position demands resourcefulness, strong interpersonal and negotiation skills coupled with ability to prioritize, in addition;
• Excellent proven customer service skills
• Ability to analyze reports
• Ability to prioritize caseloads
• Must be adaptable and able to deal with ongoing change management
• Excellent communication skills, oral and written
• Strong organizational and prioritization skills
• Ability to be a team player with strong interpersonal skills
• Ability to handle fluctuating work volumes and multiple tasks within a fast paced environment
• Ability to influence, convince, direct and persuade others
• Excellent problem solving skill
NURSE CASE MANAGER cont’d
Goal and Objectives for the Nurse Case Manager
The primary goal of the case management process is to provide services that ensure appropriate, quality care for individuals who are at risk, in a timely and cost-effective manner.
The objectives that the case management process strives to achieve include:
Assist the client and family to achieve optimum function;
Coordinate the delivery of cases, decrease fragmentation and assure appropriate use of resources;
Enhance the quality of life for the individual patient/family;
Improve and facilitate interdisciplinary communication and planning;
Help to strengthen the family unit when injury and illness strike;
Maximize the health of consumers by increasing health care education that promotes wellness;
Proactively identify problems and needs, and implement services that provide appropriate high quality care to meet the individualized needs of the patient/family.
Cost management while ensuring highest level of care
The Nurse Case Manager has responsibility for the assessment, planning, implementation, and evaluation of group health, disability and emergency medical travel assistance, interpretation of medical reports, medical case management, policy benefit analysis and pay ability determination for individual and groups of insured and other clients.
Accountability / Responsibility:
• Meeting the needs of the client and activities related, as well as meeting the provisions of their policies and procedures.
• Accountable to the Team Leader
• Functions within the Active Claims Management Inc. Policies and Procedures.
• Participates in committees associated with Active Claims Management Inc.
• Participates in providing in-service education to other staff members.
• Attends company meetings
• Attends outside workshops for professional development.
Duties:
• Assumes responsibility as Primary Medical Case Manager for a particular client, upon notification of case.
• Utilizes a systems approach to data collection; continually assessing, planning, and completing the necessary documentation.(detailed explanation below)
• Analyse data in the formulation of nursing diagnosis and sets out objectives to meet the needs of the insured and the client.
• Develops and establishes a plan of action
• Updates plan of action for insured as needed
• Evaluates the plan of action to reflect the changing status or needs
NURSE CASE MANAGER cont’d
Case Management Goal and Objectives cont’d
• Involves the Manager Clinical Services, other team members, Physicians, Care givers, Insurer, next of kin, Friend(s) (where appropriate), in planning and implementing the plan of action.
Case Management is a cyclic event essentially everyone on the team continually performs the following steps with every interaction.
ADPIE
Assessment
Diagnosis (working diagnosis)
Plan
Intervene
Evaluate
1. Assessment -
Systematically collects data, in consultation with the client and health care and other providers, about the health and medical treatment of the client and other appropriate issues.
1.1 Collects client centered data in an efficient and effective fashion.
1.2 Identifies relevant sources of data.
1.3 Employs a wide range of professional strategies to collect data.
1.4 Integrates knowledge of pathophysiology, current medical management, concepts of aeromedical physiology, pharmacology, and human behavior.
2. Planning -
Develops case specific management plan, in accordance with appropriate insurance benefits, for individual and groups of client, utilizing resources in an effective and efficient manner.
2.1 Establishes measurable and achievable outcomes for individual client.
2.2 Collaborates with the client, family, provider and colleagues in planning.
2.3 Continuously modifies priorities in response to client centered corporate and other appropriate demands.
2.4 Provides informational and planning to support to Assistance Coordinators.
3. Implementation -
Systematically implements case management plan, modifying in response to case specific and other data in a cost efficient manner.
3.1 Co-ordinates implementation of case management plan with clients, providers and colleagues.
3.2 Updates client, providers, colleagues, and others as appropriate on changes to the case management plan.
NURSE CASE MANAGER cont’d
3.3 Practices in accordance with the Standards of Practice of the College of Nurses of Ontario, insurance policy benefits and corporate policies and procedures.
3.4 Demonstrates accountability for actions.
4. Evaluation
Systematically evaluates own practice, client centered, and corporate outcomes in reference to case specific and corporate goals.
4.1 Continuously modifies case management plan and practice based on valuation of outcomes.
5. Documentation
Documents clearly, concisely and effectively in client file, to facilitate communication with colleagues and case management in accordance with corporate policy and College of Nurse's standards.
5.1 Documents medical reports and interpretation medical information to facilitate comprehension by non-medical colleagues.
5.2 Documents Daily Rounds discussion, decisions and case management actions clearly and concisely.
6. Interpersonal
Communication and Relationship - Demonstrates knowledge and skill in human behaviour and communication, utilizes effective verbal, non-verbal and written communication strategies.
6.1 Utilizes effective interpersonal communication skills to maintain positive working relationship with colleagues.
6.2 Utilizes therapeutic communication skills to provide support to insured clients and families.
6.3 Communicates with providers in a professional goal directed manner.
7. Specific Duties
Determines the impact of past health history on the pay ability of claims, in accordance with policies and procedures.
7.1 Determines policy benefits and limitations, in accordance with individual insurance contracts.
7.2 Assess claim value and projects claim reserve in accordance with policies and procedures.
7.3 Provides on call medical unit support as needed to Assistance Coordinators.
8. Leadership Concepts
Performs in a leadership role as appropriate, to experience medical knowledge, language skills and opportunity.
8.1 Delegates activities and responsibility appropriately.
8.2 Shares expertise and experience fittingly with others and acts as medical resource to colleagues.
8.3 Participates in Daily Rounds, case management discussions, and supports change process.
9. Professional Responsibilities
Practices in accordance with professional, legal and ethical standards.
9.1 Seeks opportunities for professional advancement.
9.2 Protects client's rights to privacy and confidentiality.
9.3 Functions in accordance with Canadian Nurses Association Guidelines for Ethical Behavior.
9.4 Demonstrates understanding of quality improvement and risk management.
INSERT CODE OF ETHICS FOR REF NURSES
PROFESSIONAL ASSOCIATIONS