Care Manager, RN

JOB SUMMARY:

Under direction of the Nurse Manager of Clinical Services, the RN Care Manager is responsible for triaging, coordination, documentation, communication, and tracking of patient calls, cases and records for a panel of high acuity Traditional Medicare and Medicare Advantage Plan patients in the Chronic Care Management (CCM) Program.

Chronic Care Management services provide a minimum of 20 minutes per calendar month of non-face-to-face communication (electronic or phone) with patient (or HIPAA Rep) and clinical staff, physician or other qualified health care professionals. However, the frequency and length of calls is not limited to 20 minutes each month and is conducted as the patient's medical condition warrants. During this call an initial Care Plan is established and implemented, or the annual Comprehensive Care Plan is reviewed and/or revised and documented in the patient's chart.

A Comprehensive Care Plan is an electronic summary of the patient's physical, mental, cognitive, psychosocial, functional, environmental and social assessments. It contains a record of all recommended preventive care services, medication reconciliation with review of adherence and potential interactions and oversight of patient self-management of medications, an inventory of clinicians, resources, and supports specific to the patient; including how the services of agencies and/or specialists unconnected to the designated physician's practice can be coordinated. It includes ensuring that ER and hospital clinical documents, consult notes and other records of care are current and available on the chart for review as needed.

The RN Care Manager is responsible for ensuring that care and services are delivered appropriately and timely to his/her panel of patients. Under direction of and collaboration with the primary care provider and the Nurse Manager of Clinical Services, the RN Care Manager identifies the appropriate level of care needed by each patient in his/her care. He/she oversees and ensures that each CCM patient receives a thorough assessment and Care Plan initially and annually; and as their ongoing condition and acuity status requires.

The RN Care Manager coordinates efforts with the Quality Department to ensure that each patient is accurately assessed, and that Annual Wellness Visits are completed quality measures and gaps are closed. He/she accurately updates patient's problems list, diagnoses, health conditions, mediations list and Care Team and brings additional medical concerns to the primary care provider.

Knowledge/Skills/Abilities:

The RN Care Manager must be able to perform each essential duty satisfactorily. The requirements listed are representative of the knowledge, skill, and/or ability required.

Must demonstrate personal effectiveness and credibility, collaborative skills, communication proficiency and flexibility.

Must demonstrate strong decision making and documentation skills.

Possesses organizational and problem-solving skills: Identifies and resolves problems in a timely manner; gathers, analyzes and communicates information skillfully; develops alternative solutions in an organized manner.

Knows, understands and works within the scope of his/her practice. Able to delegate responsibilities appropriately to staff licensure, education, and experience.

Able to work independently and in a multidisciplinary team. Keep's leadership informed and seeks advise and/or help from management whenever needed.

Able to manage difficult or emotional customer service situations and responds to requests for customer service and assistance in a timely and appropriate manner.

Has excellent written and oral communication skills. Uses reason and speaks clearly, respectfully and persuasively in positive and negative situations, focusing on resolving conflict.

Shows respect and sensitivity for cultural diversity, promotes a harassment-free environment and fosters a non-discriminatory climate.

Keeps commitments; inspires the trust of others; works with integrity and ethically.

Adapts to changes in the work environment; demonstrates willingness to change approaches or methods as needed to best fit the situation within practice guidelines.

Essential Duties and Responsibilities:

The RN Care Manager follows and maintains a panel of high acuity CCM patients as assigned by the Lead RN Nurse Manager and/or the Nurse Manager of Clinical Services.

Is responsible to coordinate and communicate with providers, staff and patient's Care Team members (including specialists, Case Managers and patient's family and/or representative) regarding the patient's specific and appropriate acuity level of care needed, as determined by their chronic conditions, acute care events and social/living needs.

Ensures that the care patients receive is efficient, thorough, timely and is properly documented to help patients avoid ER and urgent care visits, hospital admissions and readmissions. Assists in ensuring the best quality of life possible for each patient in their care.

Works with the Nurse Manager of Clinical Services, the Quality Improvement Manager and the MSRs to identify specific patient social and preventative care needs. Facilitates resolutions when possible with resources throughout an assigned geographic area.

Provides regular reporting of activities and statistical status of the CCM patients in his/her care to the Nurse Manager of Clinical Services as directed.

The RN Care Manager helps to fill in for other Care Pod staff as needed. Participates in department rotating "on-call" schedule determined by the Nurse Manager of Clinical Services.

Participates in pertinent meetings, workshops, seminars, and related forums as directed.

Maintains confidentiality and follows HIPAA and OSHA guidelines.

Maintains current Registered Nurse License in the State of Alabama.

Please note this job description is not designed to cover or contain a comprehensive listing of activities, duties or responsibilities that are required of the employee for this job. Duties, responsibilities and activities may change at any time with or without notice.

Requirements:

EDUCATION AND EXPERIENCE REQUIREMENTS

Current Alabama Licensed Registered Nurse (RN) and 3 years of related care management, medical clinical experience and/or training is required equivalent combination of education and experience considered as determined by the Director of Quality and/or Practice Administration.

To perform this job successfully, an individual must have knowledge of Word Processing and internet software. Athena EHR experience is Preferred. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

Skill Requirements: (X = Required for job)

X Typing/computer keyboard
X Verbal communication
X Utilize computer software (specified above)
X Written communication
X Retrieve and compile information Public speaking/group presentations
X Maintain records/logs
X Research, analyze and interpret information
X Verify data and information
X Investigate, evaluate, recommend action
X Organize and prioritize information/tasks Leadership and supervisory, managing people
X Operate office equipment
X Basic mathematical concepts (e.g. add, subtract)
X Advanced mathematical concepts (fractions, decimals, ratios, percentages, graphs) Abstract mathematical concepts (interpolation, inference, frequency, reliability, formulas, equations, statistics)

Physical Requirements: (X = Required for job)

X Sitting for extended periods
X Lifting/carrying up to 20 pounds various items
X Standing for extended periods Lifting/carrying more than 20 pounds various items
X Extended periods viewing computer screen
X Repetitive Motions
X Walking
X Pushing/Pulling
X Reading
X Bending/Stooping
X Speaking
X Reaching/Grasping
X Hearing
X Writing
X Inner office/clinic travel (mileage reimbursement provided)

Other (List):

Hazards: (X = Required for job)

X Normal office environment
X Electrical current Toxic or caustic chemicals Housekeeping and/or cleaning agents Flammable, explosive gases Proximity to moving mechanical parts