Care Management Consultant
The Care Management Consultant functions within the full scope of nursing practice to ultimately assist patients through the healthcare system by acting as a patient advocate and navigator. The Care Management Consultant creates longitudinal personalized care plans for patients, collaborates with and coordinates the efforts of providers across the continuum and increasingly uses data analytics to manage the health of populations.
Essential Duties
1. Transitional and Longitudinal Care Planning and Execution
- Conducts assessments of patient/family needs by coordinating input from all health professionals and formulating a documented plan assuring continuity of care for the highest risk patients
- Coordinates continuity of patient care with patients and families following hospital admission, discharge and ER visits
- Delegates care based on situation while assuming accountability for patient outcome. Supports assistive personnel; serves as a resource and holds assistive personnel accountable to complete delegated tasks
- Along with physician hospitalists/PCPs/APPs/specialists, leads and coordinates activities of interdisciplinary treatment team required to make high risk clinical, benefit and network decisions
2. Communication and Coordination Between Care Settings
- Identifies appropriate providers, facilities, external healthcare organizations throughout the continuum of care and communicates with an interdisciplinary treatment team to develop and maintain positive working relationships with patients, families and providers
- Functions as a coordinator and manager of a defined health population across multiple care settings and for multiple physicians/health care providers or health plan counterparts
- Coordinates care across the continuum (inpatient/outpatient/community) to assure appropriate utilization of clinical and community resources
- Works collaboratively with primary care practices to offer individualized assistance with improving and maintaining quality patient care
- Guides development of multiple health care partnerships to achieve a positive health effect
- Ensures that transitions of care are completed for his/her assigned patients, and that patient has the appropriate resources to improve care outcomes and prevent readmissions. Explains system wide care management to their patients and ensures that they know how to reach them when they have questions or concerns. Considers the patient's goals and preferences when developing the patient's system wide care plan.
3. Utilization Management and Data Analytics
- Manages high risk patient care, including management of patients with multiple co-morbidities or high risk for readmission to a hospital setting, using a patient registry when appropriate
- Participates in data collection, health outcomes reporting, clinical audits and programmatic evaluation as needed
- Analyzes data to identify under/over utilization; improve resources consumption; promotes potential reduction in cost; and enhances quality of care consistent with organization strategic goals and objectives. Data includes but is not limited to predictive analysis, risk stratification, cost-benefit analyses, financial analyses; clinical outcomes; utilization and practice patterns
- Assist with on-going review / readmission root cause analysis and action plan development associated with your assigned population of patients.
4. Skills Required
- Excellent communication skills (oral and written)
- Excellent customer service skills
- Proven leadership skills
- Ability to work independently, setting priorities to coordinate care plan efficiently
- Ability to work effectively in a team environment
- Highly organized and detail-oriented
- Ability to perform multiple tasks
- Effective behavioral and educational strategies, including but not limited to motivational interviewing, teach-back method and self-management support
- Confidence to communicate and outreach to other community health care organizations and personnel
- Ability to use sound judgement, decision-making and problem-solving
Qualifications-Level 1
Current Ohio RN licensure, Licensed Social Worker (LSW) or Counselor (LPC) in the State of Ohio. Licensure.
If RN, must also have ADN with 3 years of clinical RN experience.
If LSW or LPC, Bachelor's degree in Social Work.
Strong analytical, data management and computer skills. Current working knowledge of discharge planning, utilization management, case management, performance improvement and managed care reimbursement.
Qualifications-Level 2
Current Ohio RN licensure. Must also have ADN with 3 years of clinical RN experience. Three years clinical experience and 2+ years of CM/UR/Navigator/Coordinator/leadership experience or Case Management Certification or approved alternate certification that is applicable to the assigned service area.
- Has effectively demonstrated Leader skills associated with performance as department team leader, mentor, motivator, positively influences patients and others. In addition, has demonstrated department project management skills.
- Current working knowledge of discharge planning, utilization management, case management, performance improvement and managed care reimbursement.
- Understanding of pre-acute and post-acute venues of care and post-acute community resources.
Qualifications-Level 3
Current Ohio RN licensure. Must also have ADN with 3 years of clinical RN experience. Three years RN clinical experience and 5+ years of CM/UR/Navigator/Coordinator/leadership experience or Case Management Certification or approved alternate certification that is applicable to the assigned service area.
- Has effectively demonstrated Leader skills associated with performance as department team leader, mentor, motivator, positively influences patients and others. Has demonstrated department project management skills.
- Current working knowledge of discharge planning, utilization management, case management, performance improvement and managed care reimbursement.
- Understanding of pre-acute and post-acute venues of care and post-acute community resources.
- Experience with creating and managing KPIs and/or other goal setting and monitoring techniques.
- Experience developing or leading projects.
Patient Centered Care & Behavioral Expectations
Living the Genesis Mission, Vision and Values
Performs work in a manner that is quality focused.
Treats patients, co-workers, visitors and volunteers with courtesy, compassion, empathy and respect.
Results oriented and focused on achievement of objectives.
Acknowledges and responds to the diversity of people and the situation.
Encourages peers (others) to be owners of change.
Always makes the effort to anticipate and exceed customer needs and expectations.
Possesses the ability to engage others with patience and understanding.
Acts in a manner that creates positive first and lasting impressions.
Demonstrates the ability to own issues until they are resolved.
Patient Centered Care (patients/families, physicians, co-workers, all other internal/external customers)
Introduces self and roleconnects with everyone.
Communicates effectively (i.e. advising others of actions, pertinent information, time durations, etc.) and asks for feedback.
Asks for and anticipates needs and concerns of others.
Maintains a positive work environment for staff and a healing environment for patients (i.e. safe, clean, quiet, etc.)
Maintains the dignity and privacy of each person; manages confidential/sensitive information appropriately.
Responds to requests in an appropriate and timely manner.
Exits patient/customer encounters courteously, asking if there are additional needs that can be addressed.
Promotes Patient and Employee Safety
Demonstrates safe Patient Handling (i.e. transfers, transport, care administration, nutrition, medication, etc.)
Demonstrates safe Materials Handling (i.e. appropriate use and disposal of chemicals, infectious wastes, etc.)
Demonstrates appropriate knowledge of Infectious Disease precautions and use of proper protective equipment
Demonstrates Slips/Trips and Falls Awareness.
Actively contributes to maintaining a safe, clean and quiet environment.
Working Conditions/Physical Requirements
The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
Must be able to hear, speak, see and to coordinate motor skills. Must be able to climb, lift 25 pounds, stoop and bend. Ability to collect data, interpret findings, set priorities and carry out established plan. Ability to read
HealthcareX
