Nurse (Case Management) Tripler Army Medical Center

Tripler Army Medical Center is seeking Critial CareRNs to join our growing team!  

At Tripler, you will practice alongside civilian and military health care experts and experience unique professional opportunities. Our staff serves by caring for our military but are not subject to military requirements. We operate within safe staffing standards - giving you time to provide exceptional care. 

Also known as the “big pink building on the hill”, Tripler is a 450 bed, Level II Trauma facility and participates in unique partnerships with civilian facilities to provide care to non-beneficiary trauma victims. 

Want to hear what it’s like to work at Tripler? Check it out: https://youtu.be/b6E1XBHlEyc 

In addition to salary, employees will receive an 8.9% Cost of Living Allowance (COLA); subject to change.   

Working for the Department of Defense comes with an abundance of benefits and perks to include competitive compensation packages, paid-time off, medical benefits, student loan repayments, and retirement package with Thrift Savings Plan to include matching employer contributions. For more information, please visit the following link: https://www.usajobs.gov/Help/working-in-government/benefits/ 

Serves as a Nurse Case Manager in order to provide professional case management and health planning services. The incumbent of this position serves as a member of a multidisciplinary team to provide assessment, planning, implementation, coordination, evaluation, and monitoring of patients for health options and services. The incumbent helps develop, analyze, integrate, monitor, and manage healthcare delivery systems through communication and use of resources to promote quality and cost-effective outcomes across the continuum.

MAJOR DUTIES:

1. Provides advanced practice clinical nursing, administrative and organizational skills in managing the continuity of care for the beneficiary populations. Conducts a comprehensive assessment of beneficiary’s health needs in order to develop a plan of care. Plans with the patient, the family, the physician/provider, other healthcare providers, the payer, and the community, to maximize healthcare response and quality, cost effective outcomes. Facilitates communication and coordination between members of the healthcare team. Educates both the patient and members of the healthcare delivery team about case management, healthcare and treatment options, community resources, insurance benefits, psychosocial concerns, etc., so that informed decisions can be made. Engages in problem-solving, exploring options to care when available and alternative plans when necessary to achieve desired outcomes. Encourages appropriate use of healthcare services and strives to improve quality of care and maintain cost effectiveness. Empowers patients and serves as an advocate for both patients and the healthcare team to facilitate positive outcomes.

2. Provides oversight and input to nursing practice matters. Incumbent participates in the identification of processes, systems, and practice metrics; and in determining measures of care outcomes for the population served.

a. Attends multidisciplinary meetings, identifies potential case management clients through health planning assessments, review of the multiple databases and points of contacts available for the specified population. This screening process may include, but is not limited to the Emergency Department log, physicians, nurses, Managed Care and the clients themselves.

b. Screens all potential case management clients within established timeframe after identification for appropriateness/benefit of case management services to client and/or institution.

c. Interviews and counsels potential case management clients within established timeframe as to services needed to optimize current health/psychosocial status and benefits of case management services. Once the client accepts case management, the approved metrics will be entered into a prescribed database for tracking purposes along with clinical progress notes on the client's status.

d. Introduces innovative nursing techniques, practices, and approaches in collaboration with health care providers to identify, assess, educate, plan, and coordinate care through programs designed to provide efficient, comprehensive and cost-effective service for case managed patients.

e. Coordinates with patient-focused multidisciplinary teams of clinicians to develop timeline protocols/clinical guidelines which delineate the expected process of care delivery for selected case managed patients and provide high quality affordable health care to its beneficiaries. Monitors exceptions, deviations, and differences from the established protocols to identify and report problems. Variances are analyzed and reported through a continuous process improvement channel to seek solutions and improve delivery of care. Accountable for coordination of care for select groups of complex patients to ensure desirable patient outcomes are achieved. Consults and coordinates with other multi-disciplinary care professionals, agencies, organizations, and other ancillary support systems to assist patients to optimize their level of function and self-care.

f. Conducts extensive evaluation of case management patients to establish in detail and specificity the nature of their continuity of care needs as well as causal and contributing conditions and circumstances. Conducts comprehensive clinical interviews with the patient and other family members, as warranted, collects data from all involved health care agencies, medical providers and resource programs. Participates in a multidisciplinary team to develop a treatment plan to deal with all identified conditions and problems. Identifies psychosocial aspects of anticipated care needs to identify potential barriers to optimal health and resource utilization. Identifies methods for minimizing such barriers and assists the patient and the family in developing and implementing appropriate care plans and accessing agencies and care providers.

g. Interfaces with local, state and federal agencies responsible for financing alternative programs which DoD beneficiaries may be entitled to receive. Obtains regulations, policy manuals and handouts from these agencies and develops procedural guidelines to provide access to these programs in concert with TRICARE or other governmental or private insurance coverage.

h. Identifies problems with health care access and utilization in both the military and civilian sectors and recommends alternatives to overcome these difficulties. Problem areas addressed may include admissions, outpatient visits, bill charges, acquisition of equipment and services, patient complaints and inquiries as well as population health, and quality improvement issues.

i. Assists in identifying strategies designed to improve patient access, improve adherence to population health metrics, and reduce administrative burdens for DoD beneficiaries and improve the cost effectiveness for the civilian/military health care delivery system. Obtains feedback from the Fiscal Intermediary, TRICARE and the Health Care Finders to identify problem areas. Proposes regulatory and administrative changes to resolve identified problems.

j. Provides guidance on establishing appointment protocols to match patients' needs with available resources in a timely manner. Coordinates with the medical staff to determine medical appropriateness of selected appointment alternatives in relation to timeliness of available care.

k. Develops guidelines for interfacing with the Health Care Finder Service with the equivalent functions of the civilian health care delivery system supporting TRICARE. Ensures guidelines are in compliance with program goals and that the medical staff of both the military and civilian facilities is informed of these guidelines.

l. Acts as Nurse Consultant through holistic approach to address health care needs in collaboration with all health team members to include the patient and the patient's family as warranted. Provides education and clinical assistance through advanced nursing knowledge, skills and techniques to nursing personnel, medical students, interns/residents, staff physicians and administrators. Duties include formal and informal consultation, briefings and informal/formal educational offerings. Provides first level review of DME and health consults and coordination of civilian care transfers. Represents the Medical Management Service on or before a variety of committees, boards, agencies, and concerned groups. Represents and serves as an advocate for the program, patients, and their families in obtaining services and support for their special needs.

m. Directs and manages a case managed patient population.

3. Supervisory duties: Assign work to subordinates based on priorities, difficulty of assignments, and the capabilities of employees. Provide technical oversight. Develop performance plans and rate employees. Interview candidates for subordinate positions; recommend hiring, promotion, or reassignments. Take disciplinary measures, such as warnings and reprimands. Identify developmental and training needs of employees; provide and/or arrange for needed development and training.

Performs other duties as assigned.

Must be a United States Citizen

Must possess a valid Registered Nurse License that has not elapsed/expired.

Must have an Associates, Bachelors or Master’s Degree in Nursing. This education must have been accredited by the Commission on Collegiate Nursing Education, Council on Accreditation of Nurse Anesthesia Educational Programs, Accreditation Commission for Midwifery Education, or an accrediting body recognized by the U.S. Department of Education at the time the degree was obtained.