Care Manager- Pediatric Primary Care, PPC

Cincinnati Children's•Herald, CA

2d•$81,723 - $104,208•Onsite

About The Position

The Pediatric Primary Care (PPC) Care Manager is responsible for evaluating the timeliness and availability of treatments and services, adjusting the level of service according to changing needs, and evaluating actual patient outcomes in relation to expected outcomes for the care managed population. This role identifies quality improvement opportunities, participates in the management of metrics, monitors patient progress, and utilizes Critical Pathways and/or Clinical Guidelines to track progress. The Care Manager follows through on key diagnostic and treatment tests, interacts with involved departments to expedite scheduling, and identifies, documents, and communicates barriers to the plan of care. They serve as a collaborative point person with the multidisciplinary team to manage resource usage and facilitate communication and coordination between healthcare team members. The role involves the patient, family, and caregivers in decision-making to minimize fragmentation in services, leads care coordination, and ensures smooth transitions of care by communicating essential plan components to subsequent providers. The Care Manager demonstrates an understanding of legal and regulatory issues impacting care delivery and reimbursement, negotiates and advocates for patient services and resources, and provides patient/family education. They create a safe environment by integrating patient safety goals and implement the agreed-upon plan of care. This includes providing self-management support, utilizing collaborative communication, educating patients and families, empowering problem-solving, encouraging appropriate use of healthcare services, and facilitating care transitions. Planning involves working with the patient, family, or caregiver and providers to maximize health outcomes and ensure quality, cost-effective care, establishing treatment goals, integrating patient/family decisions, and maintaining documentation. The role also involves identifying the need for patient/family team meetings, participating in them, and documenting outcomes, as well as proactively identifying medical and psychosocial services needed and reassessing the plan of care according to patient needs.

Requirements

Bachelor's degree in a related field.
ACEN/CCNE accredited BSN OR MSN OR Associate/Diploma RN AND 2+ years of experience and BSN/MSN.
5+ years of work experience in a related job discipline.
Active Ohio RN License.
May be required to obtain other state licensure.

Responsibilities

Evaluate the timeliness and availability of treatments and services and adjusting level of service according to changing needs.
Evaluate actual patient outcomes in relation to expected outcomes for the care managed population.
Identifies quality improvement opportunities such as consistent issues with smooth care progression and communicates them to the department's management/leadership team, providing supporting data and reference to evidence based practice when possible.
Participates in the management of metrics (outcomes, value, and experience) across the continuum of care.
Monitor the patient's progress in achieving the goals, objectives, and expected outcomes of the plan at specified time frames.
Utilizes Critical Pathways and /or Clinical Guidelines to monitor patient progress toward health.
Follows through on the status of key diagnostic and treatment tests and procedures to insure continued progression.
Interacts with involved departments and other members of the healthcare team to negotiate and expedite scheduling and completion of tests and procedures.
Identifies, documents and communicates barriers to the plan of care to the healthcare team.
Serves as the contact person for and works collaboratively with the multidisciplinary team to manage resource usage/utilization.
Facilitates communication and coordination between members of the health care team across all phases of care.
Involves the patient, family and caregivers in the decision-making process in order to minimize fragmentation in services.
Leads the coordination of care, setting priorities and encouraging the appropriate use and timeliness of health care services
Facilitates a smooth transition of care by ensuring that key components of the plan of care and/or patient needs are communicated to subsequent care providers across the continuum.
Demonstrates an understanding of legal and regulatory issues (HIPPA, EMTALA, regulatory agencies, CMS, legal P&P) impacting the care delivery and reimbursement process.
Negotiates and advocates for the patient for services and resources needed.
Provides patient/family education regarding post-acute services, community resources, or other needs as identified.
Creates an environment to support patient safety by integrating patient safety goals into daily practice based on the patient's age and the population served.
Implementing the agreed upon plan of care.
Provides self-management support to high risk/complex patients and families, including helping families identify and overcome barriers to care.
Utilizes collaborative communication skills to establish a working partnership with the patient/family/caregiver, treatment team, and community resources/providers.
Educates the patient, family and caregiver along with members of the health care delivery team about treatment options.
Empowers the patient, family, and caregiver to problem-solve by exploring options of care when available and alternative plans, when necessary, to achieve desired outcomes.
Encourages the appropriate use of health care services and strives to improve quality of care and maintain cost effectiveness on a case-by-case basis.
Support and facilitate all care transitions from inpatient to outpatient, practice to practice and from pediatric to adult systems of care.
Planning with the patient, family or caregiver and providers, to maximize health outcomes and ensure quality, cost effective care.
Works with the patient, family and caregiver, to establish treatment goals that meet the patient's healthcare and safety needs.
Integrates patient, family and caregiver decisions and choice into the planning process.
Coordinates the plan of care and maintains documentation of case updates and discussion/events involving individuals responsible for patient welfare (e.g. family, providers, and care team members).
Identifies the need for patient/family team meeting, participates in the meeting and documents the outcomes.
Proactively identifies medical and psychosocial services needed by the patient.
Reassess plan of care and adjusts plan according to patient needs.