The Care Manager is a clinically trained RN patient advocate striving to coordinate the delivery of the best care at the right time. The Care Manager is an integral part of the primary care multidisciplinary team. The care coordination program strives to achieve the best quality outcomes, highest patient satisfaction, highest provider/staff satisfaction and the most cost-effective care.
Works closely with primary care physician, multi-disciplinary team, physician medical directors, and others, as needed to deliver the established guidelines for chronic complex patients of all ages. Provides physicians and other health care professionals with appropriate care management tools, support, education and information to enable real time clinical decision-making. Complies with all reporting requirements, including operational protocol submittals. Provides effective care management across the care continuum and suggests and implements methods to improve cost effectiveness and quality of care.
Knowledge, Skills & Abilities: Knowledge of professional nursing theory and practice to assess, plan, implement and evaluate patient care. Knowledge of organizational policies, regulations and procedures to administer patient care. Knowledge of medical equipment and instruments, common safety hazards, and precautions to establish a safe work environment.
To perform the job successfully, an individual should demonstrate the following competencies:
Education and/or Experience:
High school diploma or general education degree (GED). Registered Nursing Degree from an accredited institution, a community college program in nursing, or an accredited university. Appropriate certificate indicating passing grade for specific specialty if working in specialty departments; e.g., rheumatology nursing exam.
Minimum one year of recent experience working in a medical facility as a registered nurse and experience taking vital signs and giving injections.
Must posses a current CPR certification and current health records with the appropriate immunization to work in the health care field (Hepatitis B and Tuberculosis).
Knowledge of ICD and CPT coding preferred; knowledge of medical terminology and managed care required.
Essential Duties and Responsibilities include the following:
Works under clinical direction of Program Director and physician medical directors. Provides effective care management across the care continuum, including coordination involving internal and external providers of care, families and other entities, as appropriate. Identifies appropriate cost effective care alternatives. Assists patients and appropriate staff, with real time decision-making in support of the coordinated care model. Care Management activities include early identification of high-risk patients, concerted planning involving physicians and mid-level practitioners, monitoring of services provided by outside physicians, home health, DME, and other providers; monitoring emergency department use as well as identifying opportunities to decrease emergency department utilization and other elements of care utilization.
Works with pertinent internal staff to ensure all requirements related to guidelines for care management, including related policies and procedures are met.
Complies with corporate compliance program and policy.
Ensures confidentiality of patient information following HIPAA guidelines and company policies.
Core Responsibilities of Care Managers:
Motivational Health Coach
Comfortable with EMR and willing to learn new technology.
Knowledge of relevant resources within the organization and community.
Other duties as assigned.
While performing the duties of this job, the employee is regularly required to stand; walk; use hand to finger, handle, or feel; reach with hands and arms and talk or hear. The employee is occasionally required to site and stoop, kneel or crouch the employee must regularly lift and /or move up to 10 pounds, frequently lift and/or move up to 25 pounds and occasionally lift and/or move up to 100 pounds.
Combination for medical office and exam/procedure room setting. The noise level in the work environment is usually moderate.