Job Description

Nurse Case Managers (NuCMs) are responsible for providing case management services to members who suffer from protracted and complex health issues. NuCM’s are involved in patient care coordination as part of the CFHS primary health care team. NuCM’s conduct comprehensive case management assessments using the case management process; provide client centered case management services to assist clients return to work; and consult with other professionals to ensure a comprehensive plan is developed.

TASKS

The required tasks for this occupational group include the following :

assess, organize, evaluate and monitor patient’s health care needs in accordance with the Health Services case management process as directed by the National Program Leadership

monitor client medical treatment plans and initiate case management action plans based on client needs and goals. These clients have complex, protracted, health care conditions likely to exceed a 3 month period and require care management or are deemed chronic

identify health care and community services supports required in order to meet clients’ specific needs;

participate in multidisciplinary team meetings and working groups, as a member of the primary health care team, to share client’s progress and provide recommendations and suggestions to decision makers such as the client’s primary care provider for the purpose of developing action plans that meet client service standards and achieve health care goals;

educate clients and families about their health condition(s) and provide them with information and eligibility criteria on benefits and entitlements;

develop and maintain a network of partnerships with internal and external community organizations within the Case Manager’s geographical area to streamline the transfer of patient care, to expand community resources to address service gaps, and provide patient a smooth transition

refer clients to specialty services as prescribed by their primary care provider such as occupational therapists, physiotherapist and monitor patient follow-ups.

Job Qualification

Education

Nurse Case Managers must, as a minimum, possess a :

• Baccalaureate Degree in Nursing from a recognized university;
• Certificate of Basic Life Support (BLS) for Healthcare Provider or equivalent such as Cardio-pulmonary Resuscitation / Automated External Defibrillator (CPR / AED) Level C. Annual recertification is required; and
• Current license to practice from a provincial or territorial College of Nurses in the province of practice.

Experience

The Nurse Case Manager shall possess, as a minimum, 3 full time equivalent years of experience within the last 4 years in nursing practice :

Other Skills and Abilities :