Nurse Case Specialist (#534030)

Provides clinical case management plans for patients with medical and mental health diagnoses and ensures that the appropriate quality of medical care is being provided.
 
 

This class is characterized by the responsibility to provide nursing case management.  The incumbent assists in ensuring that outside medical providers are meeting the medical needs of patients in the most efficient and cost effective manner.  Incumbents work within a framework of established procedures, and are expected to perform a full range of duties with only occasional instruction or assistance.  Positions at this level frequently work outside the immediate proximity of a supervisor. 
 

Receives general supervision from a Nursing Supervisor, a Nurse Manager and/or a Physician Manager.
 
Provides technical and functional oversight of lower lever health care staff.
 
 

Conducts comprehensive medical and psychosocial assessments for new and continuing patients; plans, organizes, develops and monitors case management plans for patients with medical and mental health diagnoses; reviews the patient's case.
 
Provides referrals to specialty care, oral health services, mental health services, substance abuse treatment, nutritional counseling and risk reduction counseling; monitors referrals to assure maximum successful follow-up.
 
Provides patient education related to medical and psychosocial issues, with specific emphasis on treatment issues and adherence support.
 
Monitors laboratory results to bring issues to clinicians’ attention in a timely fashion.
 
Monitors immunizations for patients to ensure that they are up to date.
 
Provides referrals to clinical trials as appropriate.
 
Performs collection and reporting of health care workload and statistical information for the department.
 
Performs utilization review of all outside and on-site services; works with outside medical providers to ensure specialty care for patients, (e.g. prenatal care, surgery, etc.) is being provided; conducts follow-up to ensure that appropriate care has been provided within guidelines established by the County.
 
Provides information and support to the management staff for purposes of cost containment and evaluation of services being provided by outside medical and mental health care providers.
 
Assists in developing a comprehensive Quality Assurance Program to monitor the clinical professional services.
 
Evaluates medical services provided in the assigned facilities and services provided to specific patients by outside providers.
 
May provide an orientation program for new Registered Nurses, Licensed Vocational Nurses and other nursing support staff; provides program for monitoring skills of nursing staff annually.
 
Performs various related administrative tasks; orders and stocks supplies; completes various documents, forms and reports; prepares related medical charts and reports; provides desk assistance at the nurses station; files, copies, and faxes documents; answers incoming calls.

Knowledge of :
 
Principles, practices and skilled techniques of nursing and related medical theory.
 
Diseases commonly treated in health clinics or correctional institutions including symptoms and disease process.
 
General nutrition.
 
Medical equipment operations.
 
Use and effects of medications and immunizations.
 
Legal environment of nursing.
 
Public health education techniques and practices.
 
Community health and social services.
 
Clinic operations in a correctional facility and related protocols and procedures.
 
Medical quality assurance practices, methods, plans and procedures.
 
Skills to:
 
Utilize basic office equipment and a variety of related medical equipment, materials, supplies, and tools.
 
Ability to:
 
Plan, organize and manage a case management and quality assurance program for nursing staff.
 
Identify and evaluate the need for developing proposed changes in the practices and procedures related to medical service delivery.
 
Interpret and apply a variety of complex County, State and Federal regulations, polices and guidelines related to quality assurance.
 
Evaluate medical program effectiveness.
 
Maintain confidentiality of information.
 
Anticipate nursing, physician and inmate needs.
 
Establish and maintain cooperative working relationships.
 
Comply and ensure compliance with nursing policies, protocols and practices.
 
Maintain accurate records of recommendations and actions taken.
 
Make referrals to local and regional hospitals providing specialized medical services.
 
Communicate effectively with people of diverse socio-economical backgrounds and temperaments; demonstrate tact, diplomacy, patience and compassion. 

Experience:
 
Three years of nursing experience in a clinic, correctional or hospital setting one year of which must have been reviewing medical records for purposes of compliance with utilization review standards.

Education/Training: 
  
Associate’s degree in Nursing or diploma in Nursing from a three year RN program.

Possession of a valid Registered Nurse license issued by the California State Board of Registered Nursing.
 
Possession of or ability to obtain a valid Class C California driver's license may be required.
 
Possession of a current CPR certificate.
 
 risk of moderate injury or illness.

Independent travel may be required.
 

Physical Ability :  Tasks require the ability to exert moderate, though not constant physical effort, typically involving some combination of climbing and balancing, stooping, kneeling, crouching, and crawling, and which may involve some lifting, carrying, pushing and/or pulling of objects and materials of moderate weight (12-20 pounds).
 
Sensory Requirements:  Requires the ability to recognize and identify similarities and differences between shade, degree or value of colors, shapes, sounds, forms, textures or physical appearance associated with job-related objects, materials, tasks or people.
 
Environmental Factors:  Requires the ability to work under conditions where exposure to environmental factors poses a moderate risk of moderate injury or illness.