Care Manager I

1 week ago

Beckley, West Virginia, United States Appalachian Regional Healthcare Full time
Job Summary

We are seeking a highly skilled Care Manager I to join our team at Appalachian Regional Healthcare. The successful candidate will be responsible for coordinating the care and services of selected patient populations across a continuum of care, ensuring optimal quality, clinical, and cost outcomes.

Key Responsibilities
  • Coordinate and collaborate with physicians, providers, multidisciplinary teams, and other healthcare professionals to ensure patient goals, plans of care, and progress are met.
  • Develop, implement, interpret, and maintain work standards and procedures that comply with ARH's policies and governmental regulations.
  • Maintain up-to-date knowledge in the field to recommend new services, products, and equipment.
  • Assess, develop, implement, and monitor comprehensive plans of care through an interagency multi-disciplinary team process in conjunction with patients and families.
  • Revise and adjust plans of care daily to accommodate individual patient needs based on continuing assessments of patient condition.
  • Assume responsibility and accountability for care plans and effectiveness, as well as patient outcomes.
  • Assess the appropriateness of care levels, diagnostic testing, clinical procedures, quality, and clinical risk issues, and document medical record completeness.
  • Review patient admission data to determine suitability of care levels in accordance with hospital-sanctioned ISDA criteria and/or other established criteria.
  • Develop, implement, monitor, and evaluate clinical pathways and clinical pathway variances.
  • Monitor patients' progression through clinical pathways.
  • Communicate continually with patients, families, medical staff, caregivers, and third-party payors as necessary.
  • Assist patients and families with educational processes prior to admission, during hospital stays, and after discharge, as indicated.
  • Ensure patients understand third-party payer guidelines and arrange discharge and planning referrals as ordered by patients' physicians.
  • Develop and maintain a positive work climate and support the overall team effort of the hospital.
  • Assist in collecting and analyzing outcome data.
Requirements
  • BSN preferred with 5 years of experience in a hospital/community setting.
  • Or
  • Must complete BSN or degree in other related field within 5 years.
  • Or
  • RN with MSN or degree in other related field with 3 years of experience.
  • And
  • Must meet all licensure and certification in the state working.
  • Or
  • Must obtain Certification of Case Management Society of America.
  • Plus
  • Excellent oral and written communication skills.
  • Must possess skill and proficiency in applying highly technical principles, concepts, and techniques central to the nursing profession.
  • Must possess proven excellent organizational skills.
  • Must have a valid driver's license in the state working.
  • Must travel to patients' residences, agencies, network providers as necessary.
  • Required to be cross-trained in UR, QA, discharge planning, and infection control.

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