RN Case Manager - Ryan White
AIDS Healthcare Foundation - Jacksonville, FL

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AMAZING INDIVIDUALS WORKING FOR POSITIVE PEOPLE...at AIDS Healthcare Foundation! Does the idea of doing something that really makes a difference in people's lives while being well compensated intrigue you? Are you looking to work for an organization that encourages growth and success from each and every one of its employees? If so, AIDS Healthcare Foundation is the place for you! Founded in 1987, AIDS Healthcare Foundation is the largest specialized provider of HIV/AIDS medical care in the nation. Our mission is to provide cutting edge medicine and advocacy, regardless of ability to pay. Through our healthcare centers, pharmacies, health plan, research and other activities, AHF provides access to the latest HIV treatments for all who need them. AHF's core values are to be: o Patient-Centered o Value Employees o Respect for Diversity o Nimble o Fight for What's Right STILL INTERESTED? Please continue! Essential Duties & Responsibilities Includes the following. Other duties may be assigned. Maintains extensive knowledge regarding the current standards of HIV/AIDS care and case management processes. Disseminates information and educates the provider community and patients regarding the latest treatment protocols in HIV/AIDS management. Interviews patients and families to assess needs and risk categories to develop and implement appropriate plans of care. Establishes long and short term goals for the patient/family which are S-M-A-R-T (Smart, Measurable, Achievable, Realistic, Timely) Creates an individualized plan of action in collaboration with the patient, family, medical caregivers and community agencies. Implements, monitors and evaluates the plan of care and its effectiveness. Revises as necessary. Monitors hospital, emergency room, outpatient and ancillary services; lab values and patient satisfaction to determine program effectiveness according to program polices, procedures and AHCA contractual requirements.. Educates patients regarding the disease process and medications, methods for improving medication compliance, available community resources and other pertinent information. Reviews medical records to identify needs and tracks outcomes according to program policies, procedures and AHCA contract requirements.. Collaborates with ASO's, PAC Providers and other Community Services as necessary to ensure appropriate access to service and follow up on the results to such referrals. Documents effectively in the Positrak computer system and tracks outcomes of care on an individual and aggregate basis regarding the patient and provider population according to program policies, procedures and AHCA contract requirements. Reports all complaints and grievances to Regional Manager. Assists in tracking, resolving and reporting of complaints/grievances. Maintains all member protected health information in a confidential HIPPA compliant manner according to AHF policies and procedures. Completes all mandatory education on an annual basis and maintains professional continuing education requirements on a bi-annual basis Participates in Quality Improvement program. Conducts care management duties in compliance with AHF policies, procedures, NCQA standards and AHCA contract. RNCM Responsibilities When Performing Field Duties Conducts 90% of all new PAC assessments within five days of notice and document 100% of all attempts and completion in PosiTrak. Conducts 90% of all level 9 DM eligible assessments within 30 days of inclusion on the roster and document 100% of all attempts and completion in PosiTrak. Completes 90% of reassessments* of PAC, PACDM and DM members within 60 days of due date. Documents 100% of attempts to schedule appointments and completion of reassessment in PosiTrak. Completes 95% of all care plans within 30 days of assessment and sends to member and Primary Care Provider within 1 week of completion. Documents all Care Plan activity in Care Plan and Progress notes. Documents all attempts to contact eligibles and existing members in PosiTrak. Such attempts include but are not limited to: ? Phone calls ? Phone messages ? ASO, provider inquiries ? Drive by visits ? Mailings Performs and documents hospital visits: ? To follow up on notices of member admission ? To orient hospital Utilization and Case Management Departments about the DM program ? To asssit with discharge planning. Performs and documents Medical Provider office visits in order to: ? Orient new providers to the program ? Collaborate with provider in development of care plan ? Update care plan, assist provider with adherence issues ? Review medical record ? All MD office visits Performs member home visits to provide: ? Education ? Medical and environmental assessment ? Adherence assessment ? Referral to medical provider and/or community resources Performs visits to members without phones - PRN per arrangements made with client and/or Team Coordinator Performs PAC exception request visits as requested by PAC Utilization Management Nurse or Regional Manager. Adheres to PAC Manual when delivering PAC assessment or reassessment services. Attends community meetings, events, health fairs as assigned by Regional Manager. Submits monthly reports on time 95% of the time. Those reports include, but are not limited to: ? Monthly narrative ? Monthly Grid (located on K-Drive)* ? Discuss with Team and submit as Team case study - Jan, March, May, July, Sept. Nov. ? PAC Service Report* ? Complete Medical Chart* Completes data entry of all care management activities by last day of month Responds to incoming phone calls within the same work day for phone calls received before 2 p.m. and within the next business day for calls after 2 p.m. Assist Team Members as needed Conducts care management and PAC services according to the policies and procedures of the DM Program. Assists Team Coordinator RNCM with desk and field tasks as needed Conducts Provider/Hospital orientations/visits as assigned by Regional Manager Attends community meetings, events, health fairs etc. as assigned by Regional Manager RNCM Responsibilities When Performinmg Team Retention Coordinator Duties When performing the Team Retention Coordinator duties the RNCM is a assigned a complete team roster and performs the following functions: ? Completes draft and final roster review process, i.e., research for appropriateness and drops/changes/disenrollments, etc. within five days after receipt of roster. Reports findings to Team and Regional Manager on a monthly basis. Contacts all assessed Level 2 and 3 members on a monthly basis. Completes the contacts per the following standards: ? 100 % of all assigned Level 2 and 3 members have had documented contact attempts at least four times (e.g., once per week until contacted) during the month, ? 100% of all contacted Level 2 and 3 members have documented MTMP, Care Plan review, standardized health progress interview question answers and SF12s where appropriate, documented in the progress notes. ? Updates care plan as necessary due to information gleaned during contact. ? Reports unsuccessful contacts to Regional Manager and Team members on a monthly basis. ? Institutes lost to follow up protocol with Team members when needed to re-establish member contact. Contacts all assessed Level 1 members on a quarterly basis. Completes the contacts per the following standards: ? 100% of all assigned Level 1 members have had documented contact attempts at least four times during the quarter(e.g., once per week during the third month of the quarter until contacted) ? 100% of all contacted Level 1 members have documented MTMP, Care Plan review standardized health progress interview question answers and SF12s when appropriate, documented in the progress notes. ? Updates care plan as necessary due to information gleaned during contact. ? Reports unsuccessful contacts to Regional Manager and Team members on a monthly basis. ? Institutes lost to follow up protocol with Team members when needed to re-establish member contact. Monitors DM Care Management Reports on a monthly basis as assigned and implements interventions with team to improve report outcomes. Reports include, but are not limited to: ? Members at risk of dropping due to no contact >180 days ? Members with reassessments due > 14 months ? Members in need of SF12 initial or follow up surveys Monitors Chart Review Report: ? Notifies team member of chart review overdue completion status on a monthly basis' ? Reports completion status to Regional Manager on a monthly basis. Monitor SF12s* Complete any overdue SF12s during contact calls & enter progress note Monitors and/or completes Care Plan update care plans per contractual requirements. Notifies team members of updates when necessary. ? Level 3 quarterly and PRN ? Level 1 and 2 every six months and PRN ? Updates PAC documentation per PAC Waiver Manual and returns to ASO within 5 working days. Documents completion and return of documents in PosiTrak. Monitor team reassessment report on a monthly basis and tracks completion: ? Communicates with Field RN concerning reassessments due each month ? Reports completion rate to Regional Manager on a monthly basis. Responds to and follow-up on any incoming calls, Documents member/provider calls in PosiTrak progress notes. Documents member calls as direct contact. Notifies Field RN of education/sick/hospital/exception visits as required and documents in PosiTrak. Visit to be discussed with both Coordinator/Field RN for agreement as to need Addresses and respond to prior authorization requests. Collaborates with PHC UM Manager for authorization determination. Notify/discuss any exception request/reassessment visits needed with Field RN Coordinates the collection of monthly narrative reports as outlined in policy and procedures and submits to Regional Manager on a monthly basis. ? Collaborate with Team and submit as team case study every other month as assigned by Regional Manager Assists Field RNCM as needed with desk and field tasks as needed Conducts Provider/Hospital orientations/visits as assigned by Regional Manager Attends community meetings, events, health fairs etc. as assigned by Regional Manager Completes monthly grid as requested by Regional Manager Participation in AHF Meetings/Committees Attends Meetings as assigned. Supervisory Responsibilities This job has no supervisory responsibilities. Qualifications To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill, and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. Education and/or Experience Minimum of an Associate's degree (A.A.) in nursing and 2 years medical/surgical nursing or comparable nursing experience, one year case management experience.. . Computer/Software Skills & Abilities To performs this job successfully an individual should have knowledge of MS Office Word processing software, Excel spreadsheet software, and DM Contact Management software. Language Skills Ability to read, analyze, and interpret general business periodicals, professional journals, technical procedures, or governmental regulations. Ability to write reports, business correspondence, and procedure manuals. Ability to effectively present information and respond to questions from groups of managers, clients, customers, and the general public. Mathematical Skills Basic Skills: Ability to add, subtract, multiply, and divide in all units of measure, using whole numbers, common fractions, and decimals. Ability to compute rate, ratio, and percent to draw and interpret bar graphs. Reasoning Ability Very High Skills: Ability to define problems, collect data, establish facts, and draw valid conclusions. Ability to interpret an extensive variety of technical instructions in mathematical or diagram form and deal with several abstract and concrete variables. Other Skills & Abilities/Qualifications Minimum one year managed care and case management experience. Excellent written and verbal communication skills. Excellent organizational skills. Knowledge of ICD-9 Coding. Clinical experience in the care of people with HIV/AIDS. Must be able to travel 50% of the time. Certificates, Licenses and Registrations Registered Nurse licensed by the State of Florida with an AS Degree; Baccalaureate Degree preferred. Valid Florida Driver's License with proof of automobile liability insurance. Certification in case management preferred.

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