Case Manager

POSITION SUMMARY:

MyCare Medical Group is a healthcare organization committed to delivering the highest quality, most cost-effective care to its patients. We are looking for an experienced Case Manager, who will be responsible for promoting patient-centered care by coordinating all aspects of inpatient/outpatient-based case management for his/her assigned area of responsibility in alignment with the goals of the Case Management Department. The Case Manager is accountable for the overall day-to-day monitoring of ancillary clinics to include care coordination, subject-matter expert, and resource advisor. Our Case Manager functions as an extension to ancillary provider clinics, monitoring and ensures that effective care coordination and case management practices are consistent with MyCare policies.

RESPONSIBILITIES:

• Daily review of Hospital and Skill Nursing Home inpatient list; considers patient's readmission status or risk of readmission and develops strategies to mitigate including education on appropriately accessing healthcare resources, preventative education, and community-based resources. This also includes:
• Daily updates from Hospital and/or Skilled Nursing Home (SNH) Case Managers
• Provide information to Hospital and/or SNH Case Manager
• Coordinate post in patient admission services and office follow up
• Obtain medical records from Hospital and/or SNH for office follow up
• Review of family dynamics and support systems
• Coordinate with Clinics & Providers with Care Team at Facilities any possible admissions and/or ER diversions to a Skilled Nursing Home
• Notify SNH admitting physician and Case Manager of any possible admissions and provide medical information as needed.
• Maintain appropriate documentation in available systems EMR and any other CM software.
• Contact high risk patients when they are no shows.
• Document in the CM software the reason and reschedule.
• Regularly interact with Clinic, Providers and their office Care Team to review elective/future inpatient and outpatient procedures. This is to include:
• Reviewing with the PCP
• Reviewing Pre-Op clearance w/ office staff.
• Notify UM/Quality Department Director of upcoming inpatient procedures.
• Review all out of the area admissions and keep a daily report.
• Daily review of office schedules to identify any patients that need Case Management intervention.
• Recent Hospital/SNH discharges
• Disease Management
• Education on Advanced Directives, Community Services information
• Case Management System:
• Maintain most current patients' information.
• Tracking system for Hospital/SNH admissions and Disease management
• To identify patients for Disease Management and follow up according to protocol
• CAD/CHF/COPD/DM/CKD Disease Management
• To manage conditions on monthly logs:
• ESRD-End Stage Renal Disease Log: Form 2728 ESRD Medical Evidence Report
• Hospice Log Certification Forms
• Oncology Log
• Transplant Log
• CAD/CHF/COPD/ Diabetes / CKD Disease Management Log
• To follow up protocols of:
• Case Management
• Disease Management
• Transitions of Care

QUALIFICATIONS:

• Required Certifications:
• Must have a current Registered Nurse (RN) license within the State of Texas, in good standing
• Must have CPR/BLS certification
• Current Case Management Certification, or must be willing to obtain during employment; Case Manager must also maintain appropriate continuing education for case management and professional licensure
• Must be a patient advocate – Case Manager will be dedicated to patient advocacy, providing empowerment through knowledge and care. Case Manager must guide their actions with ethical principles, providing service with respect for autonomy, dignity, privacy and rights of their patients.
• Must have a clinical background, preferably within referral coordination, case screening and identification, or other similar positions.
• Must have knowledge of state and federal law regulations that apply to various healthcare providers, including but not limited to:
• Confidentiality and releases of information
• HIPAA Guidelines
• Ability to multitask and organize priority of work throughout the day, managing their time accordingly, and be flexible in a results-driven, fast-paced, growth oriented, emerging company.
• Excellent computer skills, specifically with Microsoft Office (Office 365) applications (Outlook, Excel, Word).
• Must have excellent verbal and written communication skills; this position relies heavily on collaboration through consistent and thorough presentation of pertaining information.
• Ability to self-direct and work autonomously and independently; Must also work with a team, negotiating and collaborating various solutions, including leading presentations during conferences and meetings.
• Detail-oriented with strong analytical, critical-thinking, and problem-solving skills.