Medical Mgt. Program RN Case Manager

White Stone Healthcare Resources, LLC (White Stone) is an Equal Opportunity Employer and an E-Verify participant that recruits and hires qualified applicants without regard to race, color, religion, sex, sexual orientation, gender identity, age, national origin, ancestry, citizenship, disability, or veteran status. White Stone is a Service-Disabled Veteran-Owned Small Business (SDVOSB) certified by the U.S. Department of Veterans Affairs (VA). Since 2004 we have assisted the Department of Defense, VA, the Indian Health Service, the Department of Labor, and private industry with clinical staffing. We are different from a staffing agency in that White Stone healthcare professionals work within government medical facilities while remaining White Stone employees. We differentiate ourselves from our competitors by our responsiveness, our focus on employee satisfaction, and unsurpassed customer service to both employees and clients. We operate following our core organizational values of utmost Integrity, responsiveness, selflessness, and relationship. White Stone is built on Servant-Leadership, recognizing that our healthcare professionals are the heart of our team! Our goal is to position each employee for success in their job through focused intentionality and service.

The position provides Case Management services for TRICARE beneficiaries. The Case Manager RN is responsible for screening referrals for Case Management and performing a comprehensive assessment. The CM RN develops and implements an individualized Care Plan and is responsible for monitoring for effectiveness and desired outcomes. Reviews and performs reassessments as needed to ensure identified needs are addressed. CM RN is responsible for reviewing and processing authorization and referral requests according to policy. Case Manager RNs are responsible for reviewing and being knowledgeable regarding the scope of practice of their state of licensure

Applies knowledge of HIPAA privacy and security regulations as well as URAC accreditation standards to ensure compliance in daily practice. Screens beneficiary needs and circumstances with predetermined program criteria to determine appropriateness for case management. Identifies beneficiaries at high-risk for significant adverse health outcomes and with high-cost, clinical and psychological factors impacting care. Documents the process by providing the case management enrollment information and acceptance letter to the beneficiary. Provides timely decision of acceptance into the case management program and completes appropriate notifications. Completes comprehensive case management assessments. Develops individualized case management care plans to assist beneficiaries with obtaining access to quality care in a costeffective manner. Obtains necessary agreements for obtaining protected health information as needed. Makes the care plan available to the Primary Care Manager or Behavioral Health provider for information and input. Reassesses and monitors care plans for adjustments on a monthly basis, at a minimum, to address newly-identified needs, services, treatment, and funding options. Documents changes in the care plan maintained in the medical management system. Evaluates case management outcomes, assessing the individual beneficiary's satisfaction and compliance with the care plan. Prepares and presents cases involving high-profile or sensitive issues to the Medical Director for review. Functions as an advocate for the beneficiary by ensuring access to necessary care and maintaining beneficiary’s safety, locating specialized services outside the network by identifying providers, exploring nature of services offered, and facilitating process. Supports beneficiaries by providing TRICARE and community resource information and internal care referrals as needed to meet care plan goals. Understands, administers the TRICARE Specialty Program benefits, including program registration, enrollment, authorizations, and screening for high risk factors indicating appropriateness for catastrophic case management services. Monitors and provides direction to non-clinical staff. Regular and reliable attendance is required.