Patient Care Manager-Care Coordination

4 months ago

Des Moines, United States Trinity Health Full time
Employment Type:
Full timeShift:
Day Shift

Description:

Provides leadership for the Care Management Department in understanding, supporting, and reflecting the Mercy Mission. In conjunction with the Director; plans, coordinates, facilitates and evaluates Case Management/Social Work Services that contribute to the successful achievement of Mercy Medical Center. Integrates and coordinates care of individuals across the healthcare continuum. Facilitates the interdisciplinary plan of care in order to meet multiple service needs, promotes continuity through elimination of fragmentation of care/service, and facilitates the effective utilization of resources. Serves as educator and a central source of communication for the individual and their support systems. Supports functions and goals of the ACO and CIN.

ESSENTIAL FUNCTIONS:
  • Demonstrates and encourages communications and interpersonal relationships in dealing with physicians, hospital staff, patients, families and the general public, promoting a positive perception of patient care.
  • Facilitates cohesiveness with the Care Management Department.
  • Assists in managing resources to meet quality and financial goals.
  • Investigates barriers and problem areas to resolution, leading to a successful outcome.
  • Evaluates and adjusts caseloads according to organizational needs.
  • Keeps the Care Management RNs and social workers apprised of institutional information and department communication.
  • Assumes responsibility for maintaining current professional and clinical expertise. Promotes personal and professional growth among co-workers.
  • Assists the Director with department accreditation requirements.
  • Completes a comprehensive assessment of the individual's health status including clinical conditions, support systems and resources to identify needs and make referrals to appropriate multi-disciplinary services.
  • Monitors and coordinates an interdisciplinary plan of care that is in partnership with the individual and their support services for needs and services across the health care continuum and for transition through the levels and locations of care.
  • Documents the case management plan to include clinical needs, barriers to quality care and effective utilization of resources and referrals in a timely, legible manner.
  • Addresses length of stay issues and level of care changes for compliance.
  • Provides education for the individual and family and for the team regarding benefits, utilization of resources, levels of care, and expectations of the transition process throughout settings across the healthcare continuum.
  • Utilizes holistic approach (considering psychosocial, spiritual, educational, safety and related criteria) appropriate to the age of clients served.
  • Collaborates with physicians, directors, managers and staff in the collection and reporting of data to evaluate outcomes and improve quality and efficiency.
MINIMUM KNOWLEDGE, SKILLS AND ABILITIES REQUIRED:
  • Three years of R.N./Social Work clinical experience in focused areas working with multidisciplinary teams.
  • Licensed by the State of Iowa as an R.N./L.I.S.W.
  • Specialty certification preferred.
  • Proof of completion of Mandatory Reporter abuse training specific to population served within three (3) months of hire.


Our Commitment to Diversity and Inclusion

Trinity Health is one of the largest not-for-profit, Catholic healthcare systems in the nation. Built on the foundation of our Mission and Core Values, we integrate diversity, equity, and inclusion in all that we do. Our colleagues have different lived experiences, customs, abilities, and talents. Together, we become our best selves. A diverse and inclusive workforce provides the most accessible and equitable care for those we serve. Trinity Health is an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, status as a protected veteran, or any other status protected by law.

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