Care Manager - Palliative Medicine & Support Care - FT - Day

Stormont Vail Health•Topeka, KS

2d•Hybrid

About The Position

The Care Manager (Palliative Medicine) serves in an expanded nursing role to collaborate with patients and their health care team including the Palliative Medicine team, Primary Care Providers, specialists, and hospital staff and physicians to provide a model of care that ensures the delivery of quality, efficient and cost-effective Palliative Medicine services across the continuum. The Care Manager (Palliative Medicine) functions as a coordinator of patient care, assesses, plans, implements, monitors, and evaluates all options and services with the goal of optimizing the patient's quality of life. The Care Manager (Palliative Medicine) integrates evidence-based clinical guidelines, preventative guidelines, protocols, and other metrics in the development of transitions of care plans that are patient-centric, promoting quality and efficiency in the delivery of healthcare for the targeted high-risk population. The Care Manager (Palliative Medicine) monitors patients across the health continuum with a focus on effective and safe transitions through the healthcare system with a goal to optimize resources, quality of life and reduce avoidable readmissions back to acute care. The Care Manager (Palliative Medicine) manages performance feedback metrics to further refine the care model to maximize clinical, quality, and fiscal outcomes for the targeted population. This role will also complete tasks related to patient assessments, rounding with the PM&SC providers, providing support for organizing and completing of tasks with PM&SC providers, providing support of discharge processes and patient charges. The delivery of professional nursing care at Stormont Vail Health is guided by Jean Watson's Theory of Human Caring and the theory of Shared governance, both of which are congruent with the mission, vision, and values of the organization.

Requirements

2 years Nursing experience in an acute or ambulatory setting.
Registered Nurse - KSBN Required
Basic Life Support - BLS Required within 90 days of hire.

Nice To Haves

Experience with palliative care.
Case/care management experience.
Bachelor's Degree Bachelor's of Science in Nursing (BSN) Preferred

Responsibilities

Actively participates with Palliative Medicine team meetings and participates in the expansion of Palliative Medicine services.
Collaborates with the Palliative Medicine team and Palliative Medicine physicians, social work staff, and other care team members to ensure optimal care coordination for the patient.
Establish and maintain a supportive, collegial role with primary care/specialty practices engaged in improvement activity, particularly including assigned practices and their individual improvement team members.
Initiates communication with patients upon learning they have been identified as high risk / targeted population.
Pulls data from multiple systems and merge together to create a complete performance picture related to targeted populations.
Implements interventions based on data and established guidelines.
Monitors data for trends and individual outliers.
Analyzes data for process improvement opportunities to impact patient outcomes.
Provides disease/treatment specific education to both patients and families.
Guides patients through the health care system.
Participates in system wide/department patient care quality improvement activities as well as standards developments.
Works closely with the cross-functional teams to define analysis needs, identify trends and propose solutions.
Efficiently documents medical information using the appropriate forms and/or electronic applications.
Oversees scheduled appointment(s).
Oversees patient testing and admissions.
Appropriately delegates tasks and duties in the direction and coordination of health care team members, patient care, and department activities in accordance with the Kansas State Nurse Practice Act; demonstrates knowledge of KSNPA statutes and regulations.