What are the responsibilities and job description for the Care Manager position at MyCare Medical?
Care Manager – Job Description
Job Summary – The Care Manager’s primary responsibility will be to work collaboratively with the practice team to oversee and coordinate the healthcare needs of patients identified by MyCare Medical at different risk levels, focusing on improving patient outcomes, managing chronic conditions, and optimizing healthcare resources. You will act as an advocate and liaison between patients, healthcare providers, and insurance companies to ensure seamless, patient-centered care.
RESPONSIBILITIES:
- Work collaboratively with enterprise/market CMOs, PCP, Office Manager, and Medical Management to properly manage, maintain, and develop care plans for risk stratified patients.
- Develop a relationship with patients and patient’s family to help identify opportunities to improve patient’s health outcomes.
- Provide education to patients and patient’s family on disease management, advanced directives, Call Us First, Community Services and other initiatives and resources to reduce admissions.
- Conduct thorough assessments of patients' health status, medical history, and current care plans to identify gaps in care and areas for improvement.
- Implement strategies to effectively manage chronic conditions such as, but not limited to CAD, CHF, COPD, DM, CKD, ensuring appropriate medication management, lifestyle modifications, and regular follow-ups to minimize complications and hospitalizations.
- Coordinate post inpatient admission services and office follow up within 3-7 days of discharge.
- Coordinate with PCP and Care Team at Facilities on any possible admissions and/or ER diversions to a Skilled Nursing Home.
- Notify Skilled Nursing Home admitting physician and Case Manager of any possible admissions and provide medical information as needed.
- Maintain appropriate documentation and tracking, including admission and discharge information in available systems including EMR and any other CM software.
- Daily review of practice schedules and collaboration with practice team to identify any patients that need Case Management intervention.
- Contact high risk patients when they are no shows and work to get the patient properly rescheduled with the practice.
- Completion of: Mini Mental, ADLs screening, psychosocial assessment as appropriate.
- Comply with industry regulations including OSHA, HIPAA, state, and federal guidelines.
QUALIFICATIONS:
- Active Registered Nurse license in the state where you will be working with no disciplinary action.
- Proven experience in care coordination, case management, or healthcare management, particularly with Medicare beneficiaries.
- Strong understanding of chronic disease management and preventive care practices.
- Ability to navigate and quickly learn multiple systems and software programs.
- Excellent communication and interpersonal skills to build strong relationships with patients, healthcare providers, and insurance representatives.
- Analytical abilities to assess patient data, identify trends, and implement effective care strategies.
- Ability to work independently and as part of a multidisciplinary team.
- Compassionate, patient-centered approach to healthcare, with a focus on improving the overall well-being of MyCare patients.
- Experience with Microsoft Outlook, Word and Excel.
- Capacity to manage multiple or competing priorities including use of multiple computer applications simultaneously.
- Effective problem-solving skills and appropriate application of clinical knowledge.
- Experienced working with geriatric patients (preferred).
- Experience working with Value Based Care and/or Medicare Advantage Program patients (preferred)
- CPR/BLS certification
Work Schedule & Locations:
- Monday & Tuesday: Plantation, Broward Blvd.
- Wednesday & Thursday: Pompano Beach, Atlantic Blvd.
- Friday: Field-based (traveling to see patients)
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