What are the responsibilities and job description for the Care Manager - RN or LSW position at Cuyuna Regional Medical Center?
POSITION SUMMARY
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The focus of care management is identifying and managing patient outcomes across the continuum. A Care Manager is a registered nurse who manifests a high level of expertise in the assessment, diagnosis, and treatment of complex responses of individuals, families or communities to actual or potential health problems. The Care Manager coordinates and manages care of high risk, high volume, high cost patients in order to meet multiple service needs, ensure continuity of services, decrease fragmentation of care in all settings, enhance the patient's quality of life, and ensure cost containment. The Care Manager assists the patient/family in coping with illness, optimizes the patient's self-care abilities, and supports patient's rights to make choices. In addition to managing patients through an episode of illness, the care manager focuses on wellness and disease management.
This position is also responsible for Utilization Review to maximize the quality and cost efficiency of health care services by reviewing the condition of and the anticipated care and treatment of admitted patients. They partner with providers to ensure patients are admitted under the appropriate status. They work with the billing office to review and respond to insurance denials.
POSITION QUALIFICATIONS
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Education and Experience:
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If an RN, Bachelor of science/art in nursing preferred. Three years clinical experience in the acute care setting preferred. Previous Care Management and Utilization Review experience preferred.
Or must be a graduate of an accredited program of Social Work or a Baccalaureate degree in Social Work from a nationally or regionally accredited college or university. MSW preferred. Three years of experience as a social worker in the acute care setting is preferred.
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License/Certificates:
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RN License to practice in the State of Minnesota or Social Workers license in the State of Minnesota required. RN required to have Heart Association Basic Life Support (BLS) required within 30 days of hire.
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Special Skills and Aptitudes:
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- Knowledge of nursing principles, practices and techniques gained through a variety of nursing experience.
- Knowledge of community resources and support services needed to support patients and families.
- Exemplifies self-direction with good organizational, analytical and interpersonal skills.
- Knowledge and compliance of state and federal accrediting agencies.
- Must possess strong communication and problem solving skills.
- Effective interpersonal relationship skills including good listening and communication skills.
- Ability to communicate effectively in a variety of settings and with a wide variety of people and different organizational levels.
- Ability to handle confidential information discreetly and appropriately.
- Ability to develop and implement plans for program/department operations.
- Ability to adapt resources to meet the needs of the situation.
- Ability to deal with change and ambiguity.
- Ability to function independently and take independent action within the scope of job responsibilities.
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ESSENTIAL RESPONSIBILITIES
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- Screens each patient admission for medical necessity and appropriate level of care. Communicates with MD if questions regarding medical necessity/appropriate level of care should arise.
- Completes a comprehensive health assessment of the patient's physical, psychological, social, environmental, financial, behavioral health, and functional status.
- Coordinating medical treatment, including administering assessments, developing care plans, monitoring medication compliance, and more.
- Provides appropriate care for patients who will be undergoing or are recovering from orthopedic surgery.
- Builds relationships with patients.
- Assesses community, institutional, and family support systems and resources.
- Monitors patient progress toward goal achievement and patient outcomes. Facilitates appropriate exchange of information between team members and/or community agencies.
- Provides clinical data to insurance representatives to advocate for necessary treatment of patients and update the insurance review process.
- Maintains communication with payers regarding assessments, outcomes and projected length of stay.
- Acts as a resource for patient/families, interdisciplinary teams, and direct care providers.
- Provides leadership and promotes teamwork.
- Support patients in the hospital through coordinated care, discharge planning, and post hospital follow up as needed.
- Responsible for timely and comprehensive chart reviews, documentation, and consultation needed to meet the needs of patients, families, and the facility.
- Demonstrates Standards of Excellence when other duties are assigned.
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