Care Manager

Nurse Care Manager (RN)

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Monday-Friday 8am-5pm Starting Pay: $25/hour Paid Vacation and Sick Days 8 Paid Holidays Health, Vision, Dental and 401K Benefits

SUMMARY OF POSITION:

Supporting the Mission and Core Values of ACCESS Family Care, the individual in this position works cooperatively with all staff members; serving each other, our customers, and promoting a team effort and positive presence at all sites.

RN Care Manager will provide comprehensive care management services and involve: Identification of high-risk individuals and use of client information to determine level of participation in care management services; assessment of service needs; treatment plan development, which will include client goals, preferences and optimal clinical outcomes, development of treatment guidelines,, monitoring of individual and population health status; development and dissemination of reports that indicate progress toward meeting client outcomes for client satisfaction, health status, service delivery and costs.

REQUIRED SKILLS AND ABILITIES

Bilingual skills are a plus. Active, unrestricted RN license (BSN preferred) 2 years medical-surgical/outpatient experience required Prefer experience with chronic disease case management Excellent written and oral communication skills essential Computer proficiency mandatory (excel, word, outlook, PowerPoint, EMR) Excellent customer service and telephone skills are essential

ESSENTIAL DUTIES AND RESPONSIBILITIES

Develop wellness and prevention initiatives Facilitate health education groups and 1:1 with patients Participate in patient assessment, treatment plan development and goal setting for all of their health home enrollees as appropriate Assist in contacting medical providers and hospitals for admission/discharge Provide patient education regarding medical diseases, treatments, and medications Assist with obtaining, tracking, trending, and analyzing data and submitting reports as required Utilize Missouri HealthNet Division (MHD) technology program and initiatives (i.e., CyberAccess, metabolic screening, Pro-Act) Monitor and report performance measures and outcomes Provides the administrative and clinical leadership necessary to coordinate care within a patient centered medical home. Care Manager’s focus is patient-driven and concentrates on prevention and wellness as well as meeting prescribed performance monitors The RN will triage phone calls, closely collaborate with the team, and establish relationships with internal and external resources to facilitate care transitions and meet patient needs. The RN manages the patient panel by identifying clinical trends for individual patients, collecting and analyzing data and actively engaging patients in educational meetings, which may involve non face to face visits. RN Care Manager will communicate and navigate Patient Centered Health Home (PCHH) patients in collaboration with the LPN Care Manager and other team members. Priority assignments will be made with the LPN Care Manager, based on patient’s needs and risk level. Acts as the resource for direction of the LPN Care Manager for follow-up of PCHH patient needs. Identifies patients for appropriate enrollment in special program(s), (i.e MOHealthNet Health Home Initiative). Responsible for reviewing population management reports for provider patient profiles to identify patients who do not meet the health outcome quality measures RN Care Manager is responsible for documentation in EMR and may oversee performance of other team members, including the LPN Care Manager. This position is immediately responsible to the Health Home Director in collaboration with the clinic manager Demonstrates flexibility to perform other duties as assigned

SERVANT LEADERSHIP

Consistently exemplifies ACCESS Family Care’s Core Values (C.A.R.E.) with patients and coworkers: Compassion, Access, Respect, and Excellence. Exemplifies Servant Leadership Qualities: Trusted Servant, Humility, Forgiveness, Patience, Trustworthy

EMPLOYEE PARTICIPATION/TEAM EFFORT

Works cooperatively with all staff members; serving each other while promoting a team effort and positive presence at all sites Assists with the orientation and training of new Team members Initiates internal Event Report form as required, supporting continuous quality improvement throughout Access Family Care

PROBLEM SOLVING

Demonstrates good judgment by taking appropriate actions regarding questionable concerns. Follows proper reporting procedures and processes Reports needs to appropriate management Manages conflict in an appropriate and professional manner, resolving issues at the lowest level possible, and following chain of command when necessary to resolve customer issues or complaints

PRODUCTIVITY/EFFICIENCY

Manages minimum standard patient panel as directed by COO or Health Home Director. Maintains a clean and organized work area Responsive to changing work requirements.Consistently demonstrates ability to respond to changing situations in a flexible manner Minimizes non-productive time and fills slow periods with education, organizing, housekeeping, or assistance to others Organizes work areas to be able to effectively complete varied assignments within established time frames Consistently evaluates work and determines if further steps are needed to meet internal and external customer expectations Takes initiative to redo inadequate or incomplete work Meets or exceeds attendance guidelines and consistently starts work on time Assures accuracy, thoroughness, and reliability of results for the job. Takes ownership for mistakes Attends (or has an excused absence) for all mandatory in-services i.e., safety/health fairs, employee meetings, and specific departmental in-services

CUSTOMER SERVICE

Consistently demonstrates a commitment to Access Family Care’s Mission, to serve the underserved Follows dress code and appears professional while on duty Provides high quality customer services to internal and external customers Retrieves and responds to voice messages timely Greets everyone with friendliness and respect and resolves problems to the best of their ability or refers customers cordially to management Answers and manages telephone calls with pleasant telephone etiquette

SAFETY AND SECURITY

Reads and understands HIPAA regulations and applies security measures to protect the privacy of patient information Reads and understands ACCESS Family Care’s Policies and Procedures Observes safety and security procedures and uses equipment and materials properly Responds quickly and appropriately to all drills and codes conducted by management staff Reports unsafe working conditions in timely manner to management Adheres to program guidelines, policies and procedures, and reports all work related incidents/accidents timely to appropriate management and human resources Participates in safety in-services Follows proper reporting procedures for actual or potential incidents so follow up and or prevention can occur

WORKING ENVIRONMENT & PHYSICAL REQUIREMENTS

The individual in this position will have mobility within the clinic; working in an office environment with minimal exposure to temperature changes, noise, and dust. Employee may be exposed to body fluids, including blood. Regular schedules are established to meet the needs of our patients. Evenings and Saturdays may be required. Travel may be required. Typically, while performing the duties of this position the employee will sit for the majority of the workday. Close vision is required to perform the duties of this position.

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