Complex Care Manager RN

Job Description

Functions as a clinician, case manager and educator to achieve optimal clinical and quality outcomes by effectively managing care and resources to reduce unnecessary utilization. Researches, evaluates, and recommends resources to meet medical and non-medical needs of patients and families. 20%
Utilizes clinical expertise and understanding of care management, Medicare regulations, and contributes to the goals of cost containment and quality care and provides safe and appropriate transitions of care. Collaborates, refers, and communicates across all programs to ensure appropriate coordination of services.

Works collaboratively and maintains active communication with physicians, nursing, and other members of the interdisciplinary team to effect timely and appropriate patient management.
Serves as an advocate, placing the needs of patients and their families first. Delivering compassionate care that is whole person care: body, mind, and spirit. Supports shared decision making and encourages patient adherence to their care plans. Promote patient and family responsibility and self-management.

Conducts EMR reviews and patient interviews via face-to-face and/or telephonic engagements to assess, identify, and close clinical and non-clinical gaps in patient care. Evaluate changes in patient-reported symptoms and conduct additional triage and screening to determine next steps.

Assists with the collection, analysis and benchmarking of utilization, process, and outcomes metrics. Analyzes productivity. Measure outcomes and effectiveness of care management including clinical, financial, quality of life and patient/family satisfaction. Identifies opportunities for continuous improvement. Participates and promotes performance improvement projects.

The ideal candidate will possess the following qualifications:

Education
Associate's Degree Nursing Required Or
Bachelor's Degree Nursing Preferred Or
Master's Degree Nursing, Health Admin, MBA, Public Health or other healthcare related field Preferred

Experience
3 Years related clinical experience or equivalent, preferably in telephonic care management, case or disease management, home care or hospice Required

AND
2 Years acute or chronic institutional care setting Preferred

Licenses and Certifications
RN - Registered Nurse active and in good standing Upon Hire Required

AND
CCM - Certified Case Manager condition of continuing employment 18 Months Required

AND
CHPCN - Certified Hospice and Palliative Care Nurse specialty certifications strongly encouraged Upon Hire Preferred

OR
OCN - Oncology Certified Nurse specialty certifications strongly encouraged Upon Hire Preferred

OR
SCRN - Stroke Certified Registered Nurse specialty certifications strongly encouraged Upon Hire Preferred

Skills
Professional demeanor. Self-directed. Ability to work as a member of a team.
Knowledge and skill in chronic disease management
Excellent verbal and written communication (including documentation) skills.
Strong organizational and time-management
Exceptional customer service skills and understanding of patient and family care concepts
Ability to monitor, assess and record patient progress against a plan of care.
Ability to facilitate patient access to community resources.
Ability to work collaboratively with providers, vendor partners and external organizations
Ability to assess, adapt, and calmly respond to changing and crisis environment.
Ability to maintain confidentiality with all aspects of patient information in accordance with all applicable policies and regulations

Supervision
Individual Contributor