The Nurse Case Manager, hereafter referred to as the Case Manager, shall provide a full range of professional health nursing principles, practices, and procedures in clinical settings in order to analyze the full scope of problems associated with providing appropriate, cost effective care to Department of Defense (DOD) beneficiaries. The Case Manager shall collect, organize, record, and communicate data relevant to primary health assessments including a detailed medical history in order to develop time sensitive treatment plans which delineate the expected process of care delivery for selected case managed patients or populations. The Case Manager shall assess patient via the telephone, using established protocols, in order to provide appropriate and cost effective care. The Case Manager shall establish priorities for patient care monitor and evaluate progress toward the stated goals in order to provide coordinated, efficient, effective health care to its beneficiaries.
The Case Manager shall oversee discharge-planning activities in order to ensure ideal timing and sequencing of patient care. The Case Manager provides professional assistance to health care finders in order to identify patient’s needs for referrals to appropriate health care providers or facilities. The Case Manager shall negotiate, write, finalize, and administer product/service agreements to insure mutual compliance in meeting care goals.
The contractor shall have demonstrated skill in understanding diagnoses in order to assist patients to optimize their level of function and self-care. The contractor shall possess demonstrated knowledge of patient education principles and management of complex medical, psychosocial, and financial problems in order to enhance patient adherence to individualized treatment plans and train peers and staff. The contractor shall have a minimum of two years nursing experience and shall be certified as a case manager by a recognized certifying organization, i.e. Commission for Case Management Certification or American Nurse Credentialing Center.
The contractor shall possess the ability to seek feedback from peers, professional colleagues, clients, and outcomes research, in order to expand clinical knowledge, enhance role performance, and increase knowledge of professional issues. The contractor shall have the skills to effectively consult with health care providers at all levels and negotiate with outside providers for services and products in order to obtain client services and support. Contractor may be required to receive and maintain clinical practice privileges. The contractor shall maintain credentialing requirements in good standing at a local MTF.
Licensure: Current, full, active, and unrestricted license as a Registered Nurse in one of any U.S. State, the District of Columbia, Guam, Puerto Rico or U.S. Virgin Islands.
*Must be able to pass a federal background clearance at a level of TS/SCI
All HCPs shall have and maintain current certification in Basic Cardiac Life Support (BCLS) as certified by the American Heart Association. Documentation of such training shall be provided to the COR. The front and back of the BCLS shall be provided to the Credentialing Department of the MTF they are credentialed through.
Required Minimum Skills
The contractor shall possess the following skills and attributes:
• Oral and written communication skills in order to meaningfully interact with peers, outside agencies, vendors, providers, and Military Health System (MHS) stakeholders to exchange information, provide briefings, presentations, research, and metrics to demonstrate or advance effective, efficient case management practice, outcomes, and organizational/MHS value.
• Skill in team coordination, facilitation, and communication in order to facilitate the exchange of information/ education, enhance goal achievement; augment abilities of client support network, and effect change in system or policy at any level.
• Knowledge of local, state, and federal laws and regulations, professional code of ethics, and practice standards in order to ensure adherence within legal and professional parameters.
• Knowledge and skill in using pre-established utilization review criteria recognize and report actual or potential quality and risk management issues in order to improve practice, and ensure compliance.
• Knowledge and skills in the use of VA/DOD Clinical Practice Guidelines in order to ensure an evidence-based standardized process of care to military beneficiaries.
• Knowledge of the healthcare financial environment and the fiscal dimension of population health in order to ensure optimal stewardship of resources.
• Skill in use of research tools in order to critically evaluate existing practices, opportunities, and outcomes.
• Skill in management of information systems and technology in order to manage individual or population health, continuously improve practice, and effectively communicate practice outcomes to involved stakeholders.
• Knowledge of computers and software applications in order to conduct data collection, tracking, rending, and analysis. Ability to design and present computer-generated outcome analysis information in order to provide timely, effective peer and higher level educational programs or project briefings.
• Knowledge of pharmaceuticals, their desired effects, side effects, and complications of their use in order to gauge their effect on patients and their recovery.
• Knowledge of community resources, patient entitlement/benefit eligibility, and ability to access these resources in order to assist patients/families in optimizing their level of function and self-care.
• Knowledge of current third party regulations and policies, with special emphasis on TRICARE and Medicare benefits and services, in order to identify alternative financing sources to which DOD beneficiaries may be entitled.