Ambulatory Case Manager | Family Medicine Residency

Monument Health•Rapid City, SD

20h•$33 - $41•Onsite

About The Position

The Ambulatory Case Manager (ACM) supports patient care coordination in the primary care ambulatory clinic setting and/or in conjunction with the Managed Care Contracting identified goals. The ACM primary responsibility provides clinical evidence-based care management support to assist the delivery of education, self-management, and timely health care delivery to high-risk and rising-risk patients associated with the assigned ambulatory clinic and/or managed care attributed patient population. The ACM works collaboratively with the multidisciplinary care team to deliver seamless transitions through the continuum of care by guiding the patient through the healthcare system in an efficient and fiscally responsible manner to achieve desired outcomes. The ACM facilitates alliance between the health care team, patients, family/caregivers, and community by assessing, planning, and advocating for health care needs of an individual and/or identified population for quality, cost-effective outcomes. In collaboration with identified program and system leadership, the ACM will be responsible for identified data collection, management, and analysis to assess the impact of the program. The registered nurse will demonstrate performance consistent with nursing and case management professional standards of practice, care, and the Nurse Practice Act.

Requirements

Completion of a nursing education program that is approved by a board of nursing
Basic Life Support (BLS) Certification - American Heart Association (AHA) - Within 60 days of hire or transfer
Registered Nurse (RN) - South Dakota Board of Nursing

Nice To Haves

Bachelors degree in Nursing
Commission for Case Management Certification (CCMC) - Accredited University or accredited training professionals

Responsibilities

Optimize care coordination with hospital, ED, consulting physicians, and community resources as necessary.
Collaborates with physicians, providers, and practice caregivers to identify appropriate patients for care management.
Utilize evidence-based materials related to coordination of care and health transitions to facilitate identification of appropriate interventions for improvement and maintenance of health.
Maintains a working knowledge and relationship with community resources and payer benefits that link the individual with the most appropriate resources.
Assists by maintaining expertise on benefits, reimbursement and contract/regulation changes per payer, managed care contract guidelines, Medicare and Medicaid to facilitate appropriate reimbursement, education and guidance to assist the Healthcare team and patient/family in decision making.
Collaborate with the interprofessional health team across health care settings to effectively implement coordination plans while maintaining fiscal accountability and individual patient advocacy.
Collaborate with the patient and multidisciplinary team in evaluating change readiness, assessing patient needs, developing plan of care, designing teaching plans/programs, and evaluating the patient’s progress toward health care goals and attaining expected outcomes.
Educates the patient and the patient’s family/caregiver about self-management tasks they can undertake to gain greater control of their health status through patient involvement in activities to improve their health, encourage wellness, avoid preventable hospital admissions, support social determinants of health disparities and address advance care planning where applicable.
Identifies potential barriers to learning and/or care delivery and makes appropriate suggestions for change.
Responsible for the collaborative development and monitoring of identified outcomes measures.
Conducts current and retrospective clinical reviews for the purposes of determining best practice patient care outcomes including most cost effective, appropriate care for the patient, and the effectiveness of care coordination.
Anticipates the needs of the identified patient population, seeing that necessary documentation and pre-visit planning is completed or requested before patient visit.
Utilizes available resources efficiently and takes cost-effectiveness into account when assisting patients in scheduling medical services.
Stays informed of the latest developments, trends and changes in healthcare; regularly attends continuing education and training opportunities in case management field.
All other duties as assigned.