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Care Manager
2 months ago
The RN Inpatient Care Manager at Tek Ninjas coordinates the care and services of selected member populations to facilitate a safe and timely transition to the next appropriate level of care.
Key Responsibilities- Clinical Assessment and Planning: Clinically assesses, plans, implements, coordinates, monitors, and evaluates options and services to meet an individual's health needs.
- Collaboration with Healthcare Team: Partners with the healthcare team to ensure all aspects of the patient's needs, clinical, psychosocial and financial, are adequately addressed to manage the patient's timely progression of care and safe transition from acute care.
- Effective Utilization and Monitoring: Promotes effective utilization and monitors of health care resources.
- Case Management Planning: Collaborates with the interdisciplinary team to build a comprehensive case management plan to achieve optimal clinical and resource utilization outcomes.
- High-Risk Patient Identification and Referral: Using specific criteria, identifies high-risk patients who potentially require psychosocial intervention and refers the patient to the social worker.
- Readmission Prevention: Conducts patient assessments and intervenes to proactively prevent readmissions; evaluates those who are readmitted to identify causes of the readmission and implements strategies to prevent future readmission.
- Transition of Care Planning: Develops and documents a discharge/transition plan through collaboration with the interdisciplinary team.
- Financial Management: Communicates with the healthcare team and patient/caregiver regarding any issues related to payer or financial issues that may negatively influence the patient's post-acute care plan.
- Patient Progression: Monitors hospitalized patient's length of stay (LOS), actively participates, and contributes to Care Rounds, proactively works with the clinical care team to meet expected length-of-stay and clinical targets/indicators.
- Regulatory Compliance: Maintains knowledge of Federal, State, and other regulatory agency rules and regulations including The Joint Commission, CMS, Medicare, including but not limited to, knowledge of CMS rules regarding Observation status, the 2 Midnight Rule, and Medicare Inpatient Only Procedures.
- Patient Education and Resources: Provides education and resources relevant to the effective progression of care, utilization of services, appropriate level of care, and safe patient transition to the patient/family and health care team.
- Risk Management and Quality Issues: Identifies potential risk management and/or quality issues and works with the healthcare team to resolve such issues or refer them through the Chain of Command structure to the appropriate resource/committee.
- Excellent Communication and Negotiation Skills
- Data and Computer Skills
- Knowledge of Relevant Regulatory Standards
- Rapid Cycle Change or Clinical Performance Improvement Expertise
- Prior Clinical Experience in Care and Management of Hospitalized Patients
