Care Manager

Duties

• Proactively identifies patients/individuals appropriate for CM service based upon indicators of each program (i.e. Utilization data, Quality data, Clinical indicators, etc.) utilizing electronic tools, reports, and interview techniques effectively/efficiently to gather information about assigned populations and prioritizes workload appropriately to meet desired outcomes.
• Responds to referral requests in a timely manner and offers possible alternatives for assistance if referral is not appropriate for CM intervention.
• Collects and reviews information to determine strengths and barriers of the patient in 6 key areas: access to care, current problems/treatment plans (medical/mental health), psychosocial/support system (formal and informal resources), functional status/safety, financial/benefits available, lifestyle/behavior (risk factors).
• Develops a plan to address identified barriers to care collaboratively with the patient/family, provider and interdisciplinary team. Prioritizes the plan appropriately to achieve optimal outcomes (Quality, Cost, Experience) avoiding a focus on task accomplishment.
• Collaborates with interdisciplinary team to coordinate/facilitate implementation of plan demonstrating problem solving skills, effective communication and appropriate sense of urgency in providing service to avoid delays in progression of care, and over, under, or inappropriate utilization of resources (include but not limited to unnecessary ED/IP visits, greater than expected LOS, unplanned readmissions, unnecessary testing/treatment, etc.).
• Develops and maintains knowledge of Medicare, Medicaid and key payer benefits/reimbursement methodologies necessary to procure services for patients and serve as a resource to the IDT on quality, cost effective care.

Qualifications

• Graduate from school of nursing us required. BSN preferred.
• RN - Registered Nurse - State Licensure And/Or Compact State Licensure in the State of Missouri and Kansas (as needed for job assignment) required.
• BLS certification required within 90 days of start date required.
• Three years clinical experience, Care Management desired preferred.
• Behavioral health care manager requires three years clinical experience in a Behavioral Health related field preferred
• Pregnancy Care Manager requires three years clinical experience in clinical field (obstetrical nursing) preferred
• Three years of experience navigating resources and computer systems to access information required.