Patient Care Management Specialist

2 weeks ago

Upper Marlboro, Maryland, United States University of Maryland Medical System Full time
Job Overview

Company Overview:
As a leading healthcare provider, the University of Maryland Medical System is dedicated to enhancing the health and well-being of the communities we serve. Our advanced medical facilities are designed to deliver exceptional care and support for patients across various healthcare needs.

Position Summary:

The Patient Care Management Specialist plays a crucial role in overseeing the care continuum for patients. Reporting to the Care Management Manager, this position is responsible for evaluating, developing, implementing, and coordinating comprehensive care plans tailored to the needs of our patient population. The Specialist will work collaboratively within multidisciplinary teams to ensure optimal clinical and operational outcomes.

Key Responsibilities:
  1. Conduct thorough assessments to determine patient needs and coordinate appropriate treatment and discharge plans.
  2. Perform clinical evaluations and discharge screenings for all patients within the assigned caseload.
  3. Collaborate with the multidisciplinary team to create, implement, and monitor individualized care plans.
  4. Facilitate ongoing certification for patient stays in partnership with physicians and support staff.
  5. Regularly review and assess assigned cases to ensure appropriate admissions, resource utilization, and quality of care.
  6. Support operational functions by managing benefits, enrollments, applications, and re-certifications to maintain funding.
  7. Innovate and develop creative strategies for effective discharge planning.
  8. Evaluate care quality and appropriateness using established clinical pathways and protocols.
  9. Engage in continuous quality improvement initiatives and refer cases to the Quality Improvement Department as necessary.
  10. Identify and promote initiatives aimed at enhancing care system efficiency, quality, and resource utilization.
  11. Participate in the development and revision of collaborative clinical pathways.
  12. Provide community outreach to raise awareness of available services through information distribution at public events.
  13. Perform administrative tasks as required within the department.
  14. Attend management meetings as necessary.
  15. Complete reports for quarterly and annual utilization reviews.
  16. Carry out additional duties as assigned.
Qualifications:

Education:
- Bachelor's Degree in Nursing (Required)
- Master's Degree in Nursing (Preferred)

Licensure:
- State Registered Nurse License (Required)
- ACM (Accredited Case Manager) certification (Preferred)

Experience:
- Minimum of 1 year of clinical experience in a medical facility (Required)
- Minimum of 3 years of patient care experience, including at least 1 year in medical case management (Preferred)

Required Skills:
- Strong verbal and written communication skills
- Excellent interpersonal abilities
- Proficient in medical terminology

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