Care Manager - Clinic Care

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.
• Captures 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).
• Coordinates/facilitates 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.).
• Makes referrals to appropriate community resources and coordinates services to ensure continuity of care.
• Monitors effectiveness of CM services through patient reassessment and outcome analysis and revises plan as necessary.
• Compiles tracking reports/summaries as requested for measure and/or productivity purposes.

Qualifications

• All required education is a minimum requirement. Higher levels of education are acceptable.
• Bachelor's Degree in Nursing required. BSN Preferred.
• Three (3) Years Clinical experience, Care Management, Clinical experience in a Behavioral Health related field for Behavioral health care manager, Clinical experience in clinical field (obstetrical nursing) for Pregnancy Care Manager and Experience navigating resources and computer systems to access information required.
• RN - Registered Nurse - State Licensure And/Or Compact State Licensure licensed in State of Missouri and Kansas (as needed for job assignment), If operating a motor vehicle for business purposes a valid Missouri driver's license is required and BCLS - Basic Life Support is required to be obtained within 90 days of hire.