Community Care Manager - McLeod Healthier You- Full-time

Job description

Community Care Manager - McLeod Healthier You- Full-time
Job Overview
The Care Manager is responsible for coordinating patient care, supporting patients in navigating the healthcare system, and ensuring that care is delivered efficiently, safely, and in alignment with established clinical guidelines. This role serves as a liaison between patients, providers, clinical staff, specialists, and community resources to promote positive health outcomes, continuity of care, and patient satisfaction.
• The Care Manager helps identify patient needs, coordinates services, monitors progress, and addresses barriers to care while promoting communication and collaboration among all members of the healthcare team.
• Job responsibilities include those listed in competencies document
• Maintains a professional image and exhibits excellent customer relations to patients, visitors, physicians, and co-workers in accordance with our Service Excellence Standards and Core Values.
• Responsible for managing targeted populations to achieve efficient and effective care delivery.
• Shall be responsible for implementing safe, appropriate, effective and efficient:

(a) utilization management processes;
(b) care coordination activities;
(c) total cost of care initiatives; and
(d) identification, enrollment and linkage for high risk patients
• Ensures continuity of care through evidenced based methods, including, but not limited to, medication reconciliation, self-management plan, engagement of family and care givers, education and referrals.
• Creates population-based management strategies and processes (based on a solid understanding of care management, including disease management and preventive care) that help patients manage their healthcare needs and foster care quality, cost-effectiveness, and patient engagement.
• Works with interdisciplinary team to develop care plan and address gaps in care.
• Works closely with patient to understand disease specific related issues or interpret health risk assessment information to ensure patient meets or exceeds goals.
• Proactively anticipates and coordinates care services across multiple providers and care settings, provides comprehensive self-management and health education for targeted member populations
• Promotes and facilitates improved clinical outcomes and patient satisfaction, as well as efficient use of resources in order to obtain optimum value for both the patient and reimbursement.
• Performs complete assessment of patient’s current health status and available resources, including barriers which may hinder patient’s ability to achieve optimal health.
• Establishes collaborative partnerships with patients to assist them in examining patterns of health care needs, decisions, lifestyle choices, and utilization of resources that affect their health.
• Responsible for ensuring patient goals are achieved within specified time period based upon individual needs, reasonable expectations and documented outcomes.
• Demonstrates expertise in care management and serves as a resource to the interdisciplinary health care team.
• Integrates knowledge of external and internal regulatory requirements into the review and management of cases.
• Functions as the patient’s consistent point of contact, serving as a bridge across the care continuum, actively collaborating across multiple disciplines to create aligned processes for transitions of care.
• Responsible for providing both clinical patient education and health education.
• Ability to provide case management and care coordination to various populations across the system.
• Engages in quality improvement activities.
• Proficiency in using electronic health records (EHR) and other clinical software systems.
• Strong clinical assessment, critical thinking, and decision-making skills.
• Excellent verbal and written communication skills with the ability to explain medical information clearly and compassionately.
• Strong organizational skills with the ability to prioritize and manage multiple responsibilities in a fast-paced environment.
• Ability to work independently while following established guidelines, protocols, and nursing standards.
• Strong teamwork and collaboration skills.
• Ability to remain calm, professional, and compassionate during stressful situations.
• Attention to detail and commitment to accurate documentation.
• Required: Associates degree in Nursing required.
• Current unrestricted Registered Nurse (RN) license required.
• Current Basic Life Support (BLS) certification required.
• Three years of total nursing experience required
• Minimum of one year in care coordination/case management required

Qualifications/Training:
Education/Certifications/Licenses:
Experience