The Care Manager utilizes clinical skills and ability to work with the multidisciplinary teams to plan, coordinate, document and communicate all aspects of a patient’s health management needs and facilitates appropriate utilization of services. Applies critical thinking and knowledge of evidence based care to assist in the development of clinically appropriate care management plans, coordinates the delivery of care and actively engages those functions associated with patients receiving safe, efficient and effective care throughout the continuum, including linkages to community resources, internal resources and the third party payers as indicated.
Essential Duties and Responsibilities
- Requires in-depth professional knowledge and practical/applied expertise in own discipline and basic knowledge of related disciplines within the broader professional field
- Has knowledge of best practices and how own area integrates with others; demonstrates awareness of the industry, including regulatory, evolving customer demands, and the factors that differentiate the organization in the market
- Acts as a resource for colleagues with less experience; may lead projects with manageable risks and resource requirements
- Solves complex problems and takes a new perspective on existing solutions; exercises judgment based on the analysis of multiple sources of information
- Impacts a range of customer, operational, project or service activities within own team and other related teams; works within broad guidelines and policies
- Works independently, receives minimal guidance
- Explains difficult or sensitive information; works to build consensus
- Identifies trends/problems related to delays and potentially avoidable duplication and inefficiencies in the delivery of indicated care. Plan, develop, coordinate, implement and evaluate prevention, wellness, healthy life style and disease management programs, expansion and related activities. Applies established care pathways to assess the appropriateness and timeliness of the level of care, diagnostic testing and clinical procedures, quality and clinical risk issues and d completeness of documentation. Interact with patients and physicians to explore the most appropriate care coordination plan to meet the patient needs and advocates and intervenes as needed to ensure patients' needs are addressed.
- Identify, develop and coordinate targeted community interventions based on population-based needs to improve the health of children and families. Identify patients in need of assistance in transitioning from one level of care to another or requires coordination among multiple providers and/or services. Make referrals to Social Worker when patient or family needs psychosocial intervention to adhere to the care management plan. Collaborate with team members to develop a transition plan appropriate to the patient's needs. Serves as resource to general areas to identify and facilitate post-acute care needs for the more complex patient. Serve as consultant and educator to patient and family regarding planning for health care needs. Convene and conduct interdisciplinary conferences as needed to solicit input on care coordination needs of complex patients. Serve as liaison for community resources; identify areas of vulnerability between service providers.
- Communicate patient needs to appropriate professionals and follow-up as needed. Communicate continually with patients and families, physicians, multidisciplinary team members and third party payers to facilitate coordination of clinical activities and to enhance the effect of a seamless transition from one level of care to another across the continuum. Communicate with families to ensure understanding of care coordination/care management plan.
- Establish appropriate care coordination plan that includes regular clinically appropriate follow-up. Participate in setting priorities of patient needs. Confirm doctor's treatment plan and intended goals. Monitor the patient's progress toward the desired outcome. Collaborate with attending physician to establish treatment milestones to prepare patient and family for transitions in care. Facilitate referrals to the appropriate areas to expedite care, treatment and services. Secure clinical resources essential to achieve the desired outcomes. Establish lines of communication with patients and providers to collaborate on the plan of care and identify probable care needs.
- Participate in the development, implementation, evaluation and ongoing revision of care templates, clinical pathways and initiatives to improve quality, continuity and cost effectiveness.
- Participate to plan, develop, coordinate, implement and evaluate prevention, wellness, healthy life style and disease management programs, pilots and community-level interventions with community groups and payers.
- May facilitate, oversee, and lead other community outreach program or initiatives as assigned. Community Involvement and Advocacy: Health Fairs, Appropriate professional organization, educational speaking.
- Four-year Bachelor's degree or equivalent experience preferred
- Two-year Associate's degree or equivalent experience required
Bi-lingual Spanish preferred
Licenses & certifications
- RN- Case management certification, preferred
- 2-3 years community based, population health care experience preferred
- 3-5 years of direct pediatric patient care or case management or utilization management, or quality improvement in a Healthcare environment required.
- Willing to train the right candidate with Pediatric ICU/ED experience
Specific knowledge, skills, and abilities
- Maintain effectiveness when experiencing major changes in work responsibilities or environment; adjust effectively to work within new work structures, processes, requirements, or cultures.
- Use appropriate interpersonal styles to establish effective relationships with customers and internal partners; interact with others in a way that promotes openness and trust and gives them confidence in one's intentions.
- Meet patient and patient family needs; take responsibility for a patient's safety, satisfaction, and clinical outcomes; use appropriate interpersonal techniques to resolve difficult patient situations and regain patient confidence.
- Ensure that the customer perspective is a driving force behind business decisions and activities; craft and implement service practices that meet customers' and own organization's needs.
- Develop and use collaborative relationships to facilitate the accomplishment of work goals.
- Identify and understand issues, problems, and opportunities; compare data from different sources to draw conclusions; use effective approaches for choosing a course of action or developing appropriate solutions; take action that is consistent with available facts, constraints, and probable consequences.
- Take prompt action to accomplish objectives; take action to achieve goals beyond what is required; be proactive.
- Deal effectively with others in an antagonistic situation; use appropriate interpersonal styles and methods to reduce tension or conflict between two or more people.
- Effectively manage one's time and resources to ensure that work is completed efficiently.
- Accomplish tasks by considering all areas involved, no matter how small; showing concern for all aspects of the job; accurately checking processes and tasks; being watchful over a period of time.
- Set high standards of performance for self and others; assume responsibility and accountability for successfully completing assignments or tasks; self-impose standards of excellence rather than having standards imposed.
- Assimilate and apply new job-related information in a timely manner.
- Clearly convey information and ideas through a variety of media to individuals or groups in a manner that engages the audience and helps them understand and retain the message.
Communicates effectively with patients in English and Spanish (preferred)