CARE MANAGER - RN

Job Description

Position: Care Manager - RN

Department: Continuum of Care

Job Summary

The Care Manager supports clinical workflow that integrates value-based performance criteria. The position collaborates with patients, families, providers, other caregivers and disciplines to create a structure of managed care for complex patients. Care Managers help improve quality, promote safe clinical care, guide appropriate use of resources, and enhance the patient and family's healthcare experience. This position supports the care delivery team and demonstrates teamwork within the Care Management department and across other departments.Essential Duties and Responsibilities

Efficient use of electronic medical records, word documents, and spreadsheet computer programs. Knowledge of clinical workflow, case management, health care revenue cycle or population health management is preferred. Experience with data collection and analysis preferred

Professional Responsibilities:

Consistently applies established care management principles

Responsible for coordinating quality care management on assigned medically complex patients

Collaborates with the attending physician to establish a working DRG and expected LOS

Identifies and guides appropriate clinical resource utilization and helps coordinate patient referrals

Assesses discharge needs and coordinates discharge plans to meet patient and family needs

Assess readmission risk and implement a plan to reduce unplanned hospital readmissions

Supports clinical workflow for compliance with value-based performance metrics

Self-directed, displays the ability to think independently and creatively

Seeks continual knowledge development of UR, coding quality measures, payors and payment models

Knowledgeable of criteria for Medicare, Medicaid, HMO, and private insurance coverage

Maintain proficiency in-use of evidence-based/criteria guidelines InterQual

Educate physicians and nurse practitioners regarding the appropriate level of care/utilization issues

Work collaboratively with patients, families, and physicians to ensure high quality care, cost-effective care

Provide initial discharge planning assessment for both inpatient and observation patients admitted through the ED

Work with leadership to ensure targets are met for the operating/financial management

Participates as an effective team member with other Care Managers, Social Workers, and clinical caregivers

Supports physician workflow to integrate quality, customer satisfaction and efficiency metrics

Demonstrates secure and confidential access to protected health information

Completed training and educational assignments by deadlines

Coordinates effective transition of inpatients to post-discharge care providers

Apply regulatory standards within the department

Demonstrate a compassionate and caring approach towards patients and their family

Establish collaborative working relationships with others-contribute to department improvement activities and department decisions

Assist with data collection, monitoring and responding to outcome metrics for the assigned patient population

Core Duties:

Adhere to all SCRMC policy and procedure and employee performance standards

Demonstrates reliability by consistently reporting to work on time as scheduled

Contribute to effective use of salary and other department resources

Assess and mitigate safety risk and risk of hospital acquired conditions

Participates in department improvement and other activities

Demonstrates competency in performance of relevant clinical skills

QualificationsEducation and Experience

Current RN license by the Mississippi Board of Nursing

Minimum of three years of acute care clinical experience

Must be able to read, write, understand verbal and written communicationPreferred Qualifications

CPR or ACLS Certification

Minimum RequirementsEssential Skill Competencies:Interaction Skills

Effectively communicate- verbal and written; negotiation; conflict resolution; interdisciplinary collaboration; customer service attitude; ability to provide instructions and education

Other Essential Skill Competencies

Apply care management principles

CPR certification-safe workflow processes

Infection prevention

Local post-acute care services knowledge

Flexible and adaptable to changing priorities

Safe patient care delivery processes

EMR and use of other electronic software

Creative problem solving-critical/ analytical thinking

Data interpretation, meaningful analysisWorking Conditions

Frequently Continuously Sit, Walk, Seeing (Visual), Stand, Reach, Listening, Lift, Carry, Simple Grasping, Squat, Distinguishing colors, Bend Body, Fluids, Kneel, Firm Grasping, Climbing Stairs, Forearm Rotation, Hazardous Materials, Lifting up to 10lbs, Lifting 10-50lbs, Carrying Up to 10lbs, Lifting > 50lbs with assistance, Push on wheels Up to 200lbs, Carrying 10 to 20lbs, Use of Wheelchair, Push on wheels 200-400lbs, Use of Stretcher, Pulling Up to 350lbs with assistance Use of Carts, Use of Computer Exposure

Classifications: High exposure risk

Full-time