Description

Health West’s mission is Empowering our patients and communities by proactively providing quality, affordable patient-centered healthcare. Are you interested in working with a fantastic (fun) team whose mission is to provide top notch medical care to underserved communities in southeast Idaho? At Health West we pride ourselves on doing great things for people every day. Health West has an excellent benefits plan, Continuing Professional/Medical Education plans and student loan repayment/forgiveness through the National Health Services Center. We would love to have you as part of our team.

For over 40 years, Health West Inc. has provided affordable, high-quality health care and supportive services to all SE Idahoans. We have 9 medical clinics spread throughout Bannock, Power, Bingham, and Franklin County. Health West is proud of the diversity of its staff as a reflection of the communities it serves.

The reward of working at Health West is more than a paycheck and excellent benefits; it is the impact and contribution to the community that our employees’ value most. If you are passionate about improving the overall health and livelihood of your community, Health West is looking for people like you.

JOB SUMMARY

The Care Manager will manage and coordinate team-based care to provide health services to individuals, through effective partnerships with their caregivers/families, primary care provider, community resources, and other healthcare providers. The Care Manager will facilitate a shared goal model within and across settings to achieve coordinated, high-quality care that is patient and family centered.

To ensure success, the Care Manager will guide patients through the healthcare system and cultivate relationships with healthcare providers. The Care Manager must have the ability to multitask in a dynamic environment and have excellent negotiation skills.

DUTIES AND RESPONSIBILITIES

• Promote the mission, vision, and values of Health West.
• Recognize and respond to opportunities for improvement.
• Provides health education/mentoring/coaching to patients and other population health and care management team members. Coach patients/families toward successful self-management of their chronic disease.
• Utilize tools and documents that support a guided care process, collaborate with patients/family toward an effective plan of care.
  • Assess patient and family’s unmet health and social needs
  • Provide effect communication to improve health literacy.
  • Develop a care plan based on mutual goals with patient, family, and provider’s plan, medical summary, and ongoing action plan, as appropriate. Monitor patient’s adherence to plan of care and progress toward goals in a timely fashion, facilitate changes as needed.
  • Create ongoing processes for patients/families to determine and request the level of care coordination support they desire over time.
• Manage chronic care registries for all patients to ensure compliance with all preventative and chronic care tests, treatments, etc. to ensure highest quality of care.
• Facilitate patient access to appropriate medical and specialty providers.
• Tracks and contacts established patients with recent Emergency Department or inpatient hospital stays. Reconcile with patient discharge treatment plans from these facilities.
• Coordinates and facilitates communication between patient, primary care physician and other healthcare providers; provides recommendations for change in treatment plan according to evidence-based algorithm and expert supervision; supports implementation of new plan.
• Ensure effective tracking of test results, medication management, and adherence to follow-up appointments. Monitor completion of the chart records received and reconcile with the organizations EMR.
• Attend and actively participate in Care Management related training and meeting activities.
• Ensure accurate data collection for quality measures and other reporting purposes.
• Monitors patient closely (in-person, by phone, or by patient portal) for changes in severity of symptoms and medication side effects; educates patients about medications and medication side effects, as needed; encourages treatment adherence.
• Provides information to patients and health care team by answering questions and requests.
• Maintain a cooperative relationship among health care teams by communicating information; responding to requests; building rapport; participating in team problem-solving methods.
• Maintains record of care management activities according to organizational policies and procedures.
• Perform other duties as assigned.

SAFETY:

Health West Inc. enforces a safety culture whereby all employees have the responsibility for continuously developing and maintaining a safe working environment. Each employee is responsible for completing all training requirements, participating in emergency response tasks as requested, and serving on safety committees and teams as requested. In addition, employees must accept the responsibility for maintaining the safety of themselves and others by adhering to all written and verbal instructions, promptly reporting and/or correcting all hazards or unsafe conditions, and providing feedback to supervisors and management on all safety issues.

Qualifications

Professional Requirements

• Adhere to dress code, appearance is neat and clean.
• Maintain patient confidentiality at all times.
• Report to work on time and as scheduled.
• Maintain regulatory requirements, including all state, federal and local regulations.
• Represent the organization in a positive and professional manner at all times.
• Comply with all organizational policies and standards regarding ethical business practices.
• Communicate the mission, ethics and goals of the organization.
• Participate in performance improvement and continuous quality improvement activities.
• Attend regular staff meetings, in-services and complete annual education requirements.

Qualifications

• Idaho licensed RN in good standing with at least 2 years’ clinical experience. 
• Experience in caring for chronic disease patients, depression and depression treatment plans, patient education, motivational interviewing, and problem-solving techniques.
• Candidate needs effective written and verbal communication skills, demonstrated ability to establish rapport quickly with a wide range of people from all socio-economic backgrounds and cultures, with an extensive knowledge of community resources for low income individuals and older adults.