Post-Acute Care Manager

Bon Secours Mercy Health

3d•Remote

About The Position

The Post Acute Care Manager provides care to patients who are discharged to post-acute facilities and maintains a caseload according to productivity standards. This role performs and coordinates work with the patient, family or support members, inpatient case management team, and interdisciplinary care team members during post-acute admission for appropriate utilization of services, length of stay and safe discharge plan. The role communicates regularly on post-acute care of specific patients, as well as population level care and performance.

Requirements

Hire must have their nursing compact/multistate license prior to starting.
Associates of Science, Nursing (ADN) (required)
Current RN License in the state in which they are working or covered by compact (required)
2 years of nursing experience (required)

Nice To Haves

Bachelors of Science, Nursing (BSN) (preferred)
Certification for care management (preferred)
1 year of experience in skilled nursing settings (preferred)

Responsibilities

Runs daily reports for transitions of care, make assignments, and review goals of care.
Communicates at minimum weekly with skilled nursing facilities to encourage progression of care within an appropriate length of stay.
Evaluates of effectiveness of care plan with Interdisciplinary Team (IDT).
Conducts a comprehensive assessment and completes required documentation.
Performs patient outreach according to established protocols and documents in electronic medical record.
Coordinates referrals and transitions of care from one provider to another or from one care setting to another.
Provides Patient and Family or Caregiver education.
Refers to appropriate next level of care and discharge planning with facility, patient, and family or caregiver.
Conducts monthly meetings with high volume facilities on overall performance, quality, and readmissions.
Assists with standard operating procedures (SOPs) and policy development as needed.