RN- CARE MANAGER

South Central Health System • Laurel, MS, United States • $200k - $250k / year • 3m ago

JOB SUMMARY

Through the Quality Care Management department, the Quality 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. Quality 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.

JOB REQUIREMENTS

Required Licenses

[Mississippi, United States] Registered Nurse
Must have a current Mississippi license or a current compact license.

Minimum Work Experience

Minimum of three years of acute care clinical experience.

Required Skills

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.

ESSENTIAL FUNCTIONS

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.
Assesses readmission risk and implements a plan to reduce unplanned hospital readmissions.
Supports clinical workflow for compliance with value-based performance metrics.
Self-directed and able to take initiative and display 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.
Responsible for evaluating and screening potential admissions to the facility.
Maintain proficiency in the 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 collaboratively with the inpatient care manager and the utilization review department to support transitions from ED to inpatient.
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.
Completes training and educational assignments by deadlines.
Coordinates effective transition of inpatients to post-discharge care providers.
Applies regulatory standards within the department.
Demonstrates a compassionate and caring approach towards patients and their family.
Establishes collaborative working relationships with others and contributes to department improvement activities and department decisions.
Assists 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 safety risk and risk of hospital-acquired conditions and mitigates risk in the patient population.
Participates in department improvement and other activities.
Demonstrates competency in the performance of relevant clinical skills.

Interaction Skills

Effectively communicate verbally and in writing; negotiation; conflict resolution; interdisciplinary collaboration; customer service attitude; ability to provide instructions and education.

Other Essential Skill Competencies