RN Care Manager/Project Evaluator

JOB SUMMARY: Provides utilization management and systems review activities for “For My Baby & Me”. Work collaboratively with agency partners and community stakeholders and makes recommendations on protocols and systems to support optimum program/grant outcomes. 

ESSENTIAL FUNCTIONS:  

• Oversee evaluation activities including the development of effective data collection, monitoring and reporting in compliance with applicable grants (For My Baby and Me).
• Utilizes best practice standards to render medical necessity determinations. 
• Analyze, evaluate and measure project outcomes and incorporate results into sustainability and strategic evaluation planning.
• Write process and outcomes reports including quarterly performance assessments including protocol recommendations 
• Provides case consultations for complex cases and situations.
• Collaborates with interdisciplinary teams to assess physical, behavioral, social and transitional care needs and assists as needed to develop person centered, integrated, recovery-oriented service plans to meet the needs of the consumer. 
• Monitors staff for appropriateness and congruence of application of medical necessity criteria during utilization review process.  Provides training to staff as needed. 
• Assists in the recommendation of client/consumers care to designated collaborating agencies and monitors care and length of stay.   
• Recognizes quality of care issues and reports them appropriately through internal/external processes under the direction of the Nurse Executive/Director of Nursing. 
• Implements valid and reliable monitoring tools to conduct both quantitative and qualitative analysis of consumer care/quality measures in accordance with acceptable statistical and quality improvement processes/systems.   
• Manages, monitors, and reports on both concurrent and retrospective review of consumer records to ensure consumers received/are receiving the right care, in a timely and cost-effective manner and recommends solutions to improving the efficiency and effectiveness of service delivery via program administration and/or the quality improvement process.   
• Provide linkages, referrals, and coordination of care
• Other duties as assigned by nurse executive/director of nursing