Care Manager RN

7 days ago

London, Kentucky, United States South Central Health System Full time
Job Summary

As a Quality Care Manager at South Central Health System, you will play a vital role in supporting clinical workflow that integrates value-based performance criteria. You will collaborate with patients, families, providers, and other caregivers to create a structure of managed care for complex patients.

Your primary responsibility will be to help improve quality, promote safe clinical care, guide appropriate use of resources, and enhance the patient and family's healthcare experience. You will work closely with the care delivery team and demonstrate teamwork within the Care Management department and across other departments.

Key Responsibilities
  • Coordinate quality care management on assigned medically complex patients
  • Collaborate with attending physicians to establish a working DRG and expected LOS
  • Identify and guide appropriate clinical resource utilization and help coordinate patient referrals
  • Assess discharge needs and coordinate discharge plans to meet patient and family needs
  • Assess readmission risk and implement a plan to reduce unplanned hospital readmissions
  • Support 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
  • Seek 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 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
  • Participate as an effective team member with other Care Managers, Social Workers, and clinical caregivers
  • Support physician workflow to integrate quality, customer satisfaction, and efficiency metrics
  • Demonstrate secure and confidential access to protected health information
  • Completed training and educational assignments by deadlines
  • Coordinate effective transition of inpatients to post-discharge care providers
  • Apply regulatory standards within the department
  • Demonstrate a compassionate and caring approach towards patients and their family
  • Establish collaborative working relationships with others
  • Contribute to department improvement activities and department decisions
  • Assist with data collection, monitoring, and responding to outcome metrics for the assigned patient population
Requirements
  • Current Mississippi license or a current compact license
  • Minimum of three years of acute care clinical experience
  • Efficient use of electronic medical records, word documents, and spreadsheet computer programs
  • Knowledge of clinical workflow, case management, healthcare revenue cycle, or population health management
  • Experience with data collection and analysis

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