Quality Innovation, Inc. Hiring For Non-Clinical Medical Case Manager – RN BSN at North Little Rock, AR  Full Time

Scope: The non-clinical medical case manager (CM) is a licensed clinician who provides individual medical and dental readiness support to the Arkansas Army National Guard.  The non-clinical CM requires the expertise as dictated by the systematic application of specialized knowledge and skills derived from the biological, physical, and behavioral sciences, to the care, treatment, counsel, and health teaching of individuals who are experiencing changes in the normal health processes or who require assistance in the maintenance of health and the prevention or management of illness, injury, or disability.  Case management knowledge domains consist of assessment, planning, implementation, coordination, monitoring and evaluations of the options and services required to meet the ARNG Soldier’s health and human service’s needs.
 
Non-clinical case management personnel will be experienced in all aspects and qualified in their respective functional areas. The non-clinical case managers may delegate administrative responsibilities listed below to the administrative care coordinators/medical records technicians. Contractor personnel shall not perform inherently governmental functions (i.e., representation of government, decision authority, etc.)

Case Manager Processes

• Track the medical status of all assigned Soldiers from the identification of the non-deployable condition (T3, T4, P3 or P4 profiles) to its final determination – the Soldier is deployable, the Soldier enters the Integrated Disability Evaluation System, or when he or she is administratively separated from the military.  The estimated workload is up to 150 cases per case management team member.
• Performs initial interviews with Soldiers regarding the deployment limiting condition within 48 hours of notification of a Soldier with a deployment limiting condition.  Obtain releases of information from Soldier for continuity of care, and education the Soldier on the need and use of these documents.
• Assess and coordinate Soldier treatment plans with appropriate medical facilities recommended by the Soldier’s military and/or civilian health care provider(s) for Soldiers with conditions that have or will result in them being medically or dentally non-deployable.
• Educate Soldiers on resources available to improve medical and dental readiness.
• Assist Soldiers with tracking medical and dental appointments and maintain communication with the Soldier, their unit or chain of command, and the State Surgeon’s office as required.
• Obtain cases from Soldier readiness processing events (both for mobilization/activation and routine readiness), or through other means where Soldiers are determined to be non-medically or non-dentally ready – for example, annual periodic health assessments or command referrals.  The CM will attend these events as needed.
• Ensure those Soldiers referred by a provider are followed by at least one member of the case management team.
• Request profile exams/evaluations and audiology exams at the appointed physical exam center.
• Review and track health assessment (PHA, SRP) lab results contact SM and educate on lifestyle modifications.
• Establishes a list of available local resources within their state to ensure Soldiers have alternative options available to receive medical or dental care if not eligible for military health benefits.

Administrative Processes
 

• Submit case processing, medical documentation, and profile concerns to military/contacted provider through regular team meeting to review all cases in progress.
• All cases managed, regardless of type (medical or dental) or duration, must be documented in the Army National Guard electronic data system in current use (currently eCase within the MEDCHART application system).  This includes maintenance of automated referrals indicated in MEDCHART/eCase.
• Ensure all administrative charting in eCase is completed and e-case reviews are conducted quarterly to ensure that every Soldier with an open e-case is being tracked, managed, and communicated with at a minimum of every 45 days. This includes logging all communication (or attempts) in eCase (email, voice call, or personal interview).
• Be familiar with the regulations and policies that apply to Individual Medical Readiness and deployment, including AR 40-501, ARNG G-1 PPG, and other applicable guidance.
• Maintain Health Insurance Portability and Accountability Act of 1996 (HIPAA) standards and guidelines.
• Maintains Soldier medical records in accordance with Army Regulation (AR) 40-66. The case manager will ensure all medical documentation received from the Soldier and/or their medical team is retrieved from appointments and placed in appropriate electronic record (currently the Health Record Repository, part of the MEDCHART application system), as well as the Soldier’s hard copy medical record.   This includes stamping all medical documents for verification after uploading and indexing uploaded medical documents according to standard.
• Provides the State Medical Detachment Patient Administration (PAD) Officer or delegate with all relevant medical/dental documentation to be filed using a document evidencing transfer of custody from the contractor to the government.
• Communicate with delegated government personnel to track compliance versus noncompliance.
• Report Medical Readiness to the Commander or his/her designated representative.
• Monitor medical readiness electronic applications (currently MEDPROS in the MODS application system) to ensure all scheduled services are completed/updated and current medical status is reflected.
• Complete any similar duties as described above that are related to completing the mission of Soldier medical readiness.

Supervisory Processes
 

• Maintain accountability of all cases assigned to their administrative care coordinators/medical records technicians (if applicable).
• Be responsible for monthly metrics collection, and forward to the CM On Site Supervisor as required.
• Supervises all assigned administrative care coordinators/medical records technicians by reviewing work output, timesheets, providing first-step performance counseling (i.e. correct minor deficiencies), and reporting contract or performance issues to the On-Site Supervisor.  Orients new employees which includes Arkansas ARNG responsibilities and specific job requirements as appropriate.

 
Requirements
 

1. Education/Experience – Must possess an RN from an accredited college or university.  Preferred candidate should have at least one year of case management experience or at least five years of health care experience.
2. Credentialing – Must possess a valid, active, unrestricted license in Registered Nursing.
3. Security – Must be able to pass a national security background check for access into military electronic systems.
4. Must maintain active and valid HIPAA certification.
5. Must be able to operate a personal computer to input, store, retrieve and manipulate data for various reports as required.
6. Must be able to use various software programs to maintain database files and prepare reports, including Microsoft Word, Excel, PowerPoint and Outlook.

 
Quality Innovation, Inc. is an Equal Opportunity Employer and as such abides by the requirements of 41 CFR §§ 60-1.4(a), 60-300.5(a) and 60-741.5(a). These regulations prohibit discrimination against qualified individuals based on their status as protected veterans or individuals with disabilities, and prohibit discrimination against all individuals based on their race, color, religion, sex, national origin, gender identity or sexual orientation.