GiaCare

Manager

• Participate in all phases of the Case Management Program (CMP) and ensure that the CMP meets established case management (CM) standards of care.
• Provide nursing expertise about the CM process, including assessment, planning, implementation, coordination, and monitoring.
• Identify opportunities for CM and identify and integrate local CM processes.
• Develop and implement local strategies using inpatient, outpatient, onsite and telephonic communication.
• Develop and implement tools to support case management, such as those used for patient identification and patient assessment, clinical practice guidelines, algorithms, CM software, and databases for community resources.
• Integrate CM and utilization management (UM) and integrating nursing case management with social work case management.
• Maintain liaison with appropriate community agencies and organizations.
• Accurately collect and document patient care data.
• Develop treatment plans including preventive, therapeutic, rehabilitative, psychosocial, and clinical interventions to ensure continuity of care toward the goal of optimal wellness.
• Establish mechanisms to ensure proper implementation of patient treatment plan and follow-up post discharge in ambulatory and community health care settings.
• Provide appropriate health care instruction to patient and/or caregivers based on identified learning needs.

Registered Nurse – Case Manager