The Care Manager works under the supervision of leadership providing coordination of care for patients in Mosaic Life Care and the organization's service area in such a manner as to use the right resources, at the right time and at the right level of care. Utilizing a collaborative process, the Care Manager will assess, plan, implement and evaluate the options and services required to meet an individual's health and health related needs.
Strong communication skills are necessary to access available resources and communicate with providers and other members of the interdisciplinary team. The Care Manager serves as an advocate for the patient, family and the organization to promote quality, cost effective outcomes. Active participation in program development and process improvement efforts is an expectation of the role of Care Manager.
Responsibilities Proactively identifies patients/individuals appropriate for CM service based upon indicators of each program (i.e. Utilization data, Quality data, Clinical indicators, etc) utilizing electronic tools, reports, and interview techniques effectively/efficiently to gather information about assigned populations and prioritizes workload appropriately to meet desired outcomes. Responds to referral requests in a timely manner and offers possible alternatives for assistance if referral is not appropriate for CM intervention.
Collects and reviews information to determine strengths and barriers of the patient in 6 key areas: access to care, current problems/treatment plans (medical/mental health), psychosocial/support system (formal and informal resources), functional status/safety, financial/benefits available, lifestyle/behavior (risk factors). Develops a plan to address identified barriers to care collaboratively with the patient/family, provider and interdisciplinary team.
Prioritizes the plan appropriately to achieve optimal outcomes (Quality, Cost, Experience) avoiding a focus on task accomplishment. Coordinates/facilitates implementation of plan demonstrating problem solving skills, effective communication and appropriate sense of urgency in providing service to avoid delays in progression of care, and over, under, or inappropriate utilization of resources (include but not limited to unnecessary ED/IP visits, greater than expected LOS, unplanned readmissions, unnecessary testing/treatment, etc.).
Monitors effectiveness of CM services through patient reassessment and outcome analysis and revises plan as necessary. Compiles tracking reports/summaries as requested for measure and/or productivity purposes. Effectively communicates the goals and processes of assigned program to various audiences.
Communicates effectively with internal and external customers the benefits of Care management service, programs, and process for referral. Develops and maintains knowledge of Medicare, Medicaid and key payer benefits/reimbursement methodologies necessary to procure services for patients and serve as a resource to the IDT on quality, cost effective care. Maintains understanding of, and articulates the Regulatory requirements (CMS, TJC, etc) regarding Discharge Planning/Utilization Review and/or Care Management services.
Maintains a patient centered approach through ongoing communication with patient/family seeking their input and participation at all times. Bed Side rounding with inter disciplinary team Other duties as assigned Education Graduate from school of nursing. - Required BSN - Preferred Work Experience 3 Years - Clinical experience, Care Management - Preferred 3 Years - Clinical experience in a Behavioral Health related field for Behavioral health care manager - Preferred 3 Years - Clinical experience in clinical field (obstetrical nursing) for Pregnancy Care Manager - Preferred 3 Years - Experience navigating resources and computer systems to access information. - Required Licenses and Certifications Registered Nurse (RN) - State Licensure/Or Compact State Licensure - Licensed in State of Missouri and Kansas (as needed for job assignment) - Required Upon Hire Basic Life Support (BLS) - Required within 90 Days Travel Requirements Must be able to travel between various system facilities and off-site locations as needed. - No Qualifications Skills and Abilities Essential Technical/Motor Skills Hand/eye coordination; good hearing; computer skills/telephone skills, ability to read, write, and speak clearly.
Interpersonal Skills Must be able to teach, provide accurate and concise information, answer questions, demonstrate excellent leadership skills, maintain positive relationships with multiple customers, motivate and persuade others. Excellent verbal and written communication skills including sensitivity to other cultures, ethnicities and diverse backgrounds. Essential Physical Requirements Physical requirements include standing, walking, and fine motor skills; reach for items; bend, squat, sit, and climb stairs.
Sufficient strength and mobility to sit for long periods of time (depending on assignment). Ability to drive to various locations in and around the service area. Essential Mental Abilities Critical thinking skills, problem-solving skills, negotiating abilities.
Capable of determining appropriate response to emergency situations. Ability to focus and concentrate in order to correctly perform tasks despite numerous distractions and interruptions. Ability to maintain professional demeanor to communicate and interact with patients, customers and team members.
Essential Sensory Requirements Appropriate functional vision, hearing acuity, and smell. Exposure to Hazards Driving to and from various locations for the purpose of coordinating patient care/collaboration and outreach. Respiratory exposures for airborne pathogens.
Exposure to infectious pathogens. Exposure to physical hazards. Frequent contact with water/soap/detergents. 1.
Excellent skills in conceptual thinking, listening, problem resolution and planning2. Demonstrated leadership skills3. Excellent organizational skills.4.
Proficient computer skills including Office applications and electronic medical records.5. Knowledgeable about issues related to chronic illness.6. Must have access to transportation, which will allow for timely scheduled visits.
Other Skills and Abilities Excellent skills in conceptual thinking, listening, problem resolution and planning Demonstrated leadership skills Excellent organizational skills. Proficient computer skills including Office applications and electronic medical records. Knowledgeable about issues related to chronic illness.
Must have access to transportation, which will allow for timely scheduled visits.
Full time · Days shift