SUMMARY OF JOB DUTIES:
Under the direction of the Nurse Manager of Care Management, the Lead Care Manager, RN is responsible for the overall performance of the Chronic Care Management (CCM) and Transitional Care Management (TCM) programs and staff in their assigned Care Pod(s).
The Lead Care Manager, RN provides clinical and administrative oversight, support and training to their assigned Care Pod's staff, which includes RN Care Manager(s), LPN Care Manager(s), Care Coordinators and Patient Advocates. This position serves to assist the Nurse Manager of Care Management in clinical oversight, training, and documentation review. The Lead Care Manager, RN assists the Nurse Manager of Care Management in efforts to establish rapport with hospital-based case management departments, skilled nursing rehab facilities, and home health agencies. The role also assists with identifying and building relationships with preferred specialty providers throughout an assigned geographic area.
With collaboration of the primary care provider and the Nurse Manager of Care Management, the Lead Care Manager, RN assists in determining initial and subsequent patient acuity designations and patient assignments to the appropriate Care Pod team member. He/she oversees that each CCM patient receives a thorough assessment and Care Plan initially, annually and as their condition requires and that quality measures and gaps in care are being addressed by the Care Pod Staff.
The Lead Care Manager, RN performs regular audits to ensure CCM Care Pod staff accurately assesses and documents calls, cases, updates Care Team and medication lists, closing quality gaps and are bringing additional medical concerns to the primary care provider. He/she regularly provides reports and feedback to the Nurse Manager of Care Management for assigned Care Pod(s).
The Lead Care Manager, RN assists the Transitional Care Management (TCM) team and assures TCM patients are followed by the appropriate CCM staff as they transition from TCM to CCM. The Lead Care Manager, RN may assign responsibilities to an RN, LPN, or other well-experienced healthcare professional. However, their performance and involvement must be closely monitored by the Lead Care Manager, RN.
The Lead Care Manager, RN is responsible for triaging, coordination, documentation, communication, and tracking of patient calls, cases and records for a panel of high acuity Traditional Medicare and Medicare Advantage Plan patients in the Chronic Care Management (CCM) program as assigned by the Nurse Manager of Care Management and is responsible for ensuring that patients with chronic conditions in his/her care are provided with CCM services in an appropriate and timely manner.
ESSENTIAL JOB FUNCTIONS:
- Works closely with the Nurse Manager of Care Management, other CCM team members, providers, clinical and Quality staff to help ensure that the care patients receive is efficient, thorough, timely and documented to help patients avoid ER and urgent care visits, hospital admissions and readmissions. Assists in ensuring the best quality of life possible for each patient in their care.
- Provides and oversees regular communication and collaboration with the patient's primary care provider, clinical staff, specialists and outside care services for the benefit of the patient. Facilitates and executes care management strategies for the care coordination of CCM Patients, including utilization of other population health initiatives, including communications with patient's designated representatives and caregivers.
- Works closely with the Quality Improvement Manager and team to facilitate that Annual Wellness Visits are completed and gaps in care and quality measures are met for the well-being of care management patients.
- Works with the Nurse Manager of Care Management and the Quality Improvement Manager and the MSRs to identify specific patient social and preventative care needs. Facilitates resolutions (when possible) with resources throughout an assigned geographic area.
- Works closely with the Nurse Manager of Care Management to determine initial and subsequent patient acuity designations and assignments.
- Provides CCM services to a high acuity panel of Traditional Medicare and Medicare Advantage plan patients who are assigned to his/her care.
- Accurately assesses and documents opportunities for revision of medication lists, addressing gaps in care and quality measures, and brings additional medical concerns to the primary care provider as needed for patient encounters.
- Promotes and monitors regulatory practice standards and customer service expectations for all aspects of nursing and patient care pertaining to his/her Care Pod and within CCM and TCM guidelines.
- Monitors and maintains Time and Attendance for his/her Care Pod Staff members.
- Identifies staff development and training needs and ensures that appropriate training is obtained.
- Provides regular reporting of activities and statistical data to the Nurse Manager of Care Management as directed.
- Participates in pertinent meetings, conferences, workshops, seminars, and related forums as requested.
- Responsibilities include a rotating "on-call" schedule determined by the RN Manager of Care Management.
- Maintains current Registered Nursing License in the State of Alabama.
- Maintains confidentiality and follows HIPAA and OSHA Standards and guidelines.
- Maintains HR compliance and procedures.
- Ensures patient satisfaction by providing excellent service, putting Patients First Always.
Knowledge/Skills/Abilities:
The Lead Care Manager, RN must be able to perform each essential duty satisfactorily. The characteristics listed are representative of the knowledge, skill, and/or ability required.
- Must have personal effectiveness and credibility, collaborative skills, communication proficiency and flexibility. Must demonstrate strong decision making and documentation skills.
- Must be well-versed in knowledge of chronic health conditions, acute care, behavioral health and substance abuse problems.
- Excellent verbal, phone and written communication skills required.
- Able to work independently and in a multidisciplinary team.
- Must be skilled in Interaction with respect and in a professional manner with patients, staff and external customers. Demonstrates ability to lead, instruct, direct and evaluate Care POD staff.
- Responds to requests for service and assistance in a professional and timely manner; meets commitments and is dependable.
- Shows respect and sensitivity for cultural differences; educates others on the value of diversity; promotes a harassment-free environment.
- Treats people with respect; keeps commitments; inspires the trust of others; works with integrity and ethically.
- Uses reason when dealing with emotional topics. Manages difficult or emotional customer situations effectively, strives to continuously build knowledge and skill.
- Speaks clearly and persuasively in positive or negative situations; Focuses on resolving conflict.
- Possesses organizational and problem-solving skills; Identifies and resolves problems in a timely manner; gathers and analyzes information skillfully; develops alternative solutions in an organized manner.
- Provides regular reporting of data, activities and status of the CCM patients in his/her care to the Nurse Manager of Care Management as directed.
- Knows, understands and works within the bounds or his/her scope of practice. Seeks advise and/or help from management whenever needed. Able to delegate responsibilities appropriate to staff licensure, education, and experience.
MINIMUM REQUIREMENTS
- Current Licensed Registered Nurse (RN), with a Bachelor's Degree and 3 years of related care management, medical clinical experience and/or training required; equivalent combination of education and experience as determined by the Director of Quality and/or Practice Administration.
- Experience in social and care management services and patient engagement is required. Knowledge of hospitals, specialists, and ancillary health services throughout the assigned community is preferred.
- Strong computer skills and proficiency and knowledge of Microsoft Office products and internet software is required. Able to effectively utilize an electronic health record to perform and document all patient encounters. Athena EHR experience preferred.
Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
WORKING ENVIRONMENT
The position requires climbing, stooping, kneeling, crouching, reaching, standing, lifting, grasping, feeling, talking, hearing, repetitive motions, and finger use. Pushing and pulling are occasionally required. Use of a computer, keyboard, and telephone along with various office machines is an essential part of the job.
DISCLAIMER
The above statements are intended to describe the general nature and level of work being performed by the Lead Care Manager, RN. They are not to be construed as an exhaustive list of all responsibilities, duties, and skills required of personnel so classified. The Lead Care Manager, RN may be required to perform duties outside of their normal responsibilities from time to time as needed or as directed by supervision.
