Quality/RN Case Manager

Grace Health•Corbin, KY

18d•Hybrid

About The Position

The Quality Case Manager is a care team member with unique responsibilities that indirectly touch all aspects of patient care. The Quality Case Manager embraces a team-based approach and is comfortable working as part of the patient care team and/or leading teams. The functions of this position include care coordination, patient and staff education, auditing and monitoring quality initiatives. The primary focus of this role will be patient outcomes. The Quality Case Manager must be an advocate and champion of the Patient Centered Medical Home elements.

Requirements

Degree in Nursing or other pertinent healthcare Preferred.
Current license if applicable.
Experience related to quality management/performance improvement.
Experience/Knowledge applicable to job duties will be considered.
Communication
Computer/Technology
Conflict resolution
Customer service
Team building
Time management
Critical thinking
Leadership
Motivational Interviewing
Health Literacy

Responsibilities

Manages the Population Health module of Nextgen
Maintains patient registries for patient populations identified as high risk
In collaboration with the provider, care team, and patient/family develop a comprehensive plan of care for identified patients
Provides ongoing monitoring of progress toward meeting goals developed on plan of care
Meets with patient and family by phone or in person at regular intervals to assess needs and compliance with plan of care, this may involve occasional home visits
Uses motivational interviewing when working with patients to develop achievable goals
Collaborates with Baptist ACO care coordinators and Grace Health Patient Care Assistant to coordinate care of high-risk patients to achieve optimal health outcomes and all recommended preventive care
Uses teach-back methods with patients and families to assess level of understanding
Routinely uses universal precautions for health literacy when working with patients and families.
Demonstrates knowledge of performance improvement by participating in collecting, compiling, and analyzing patient data
Communicates specific pieces of the plan of care to appropriate care team members
Working with Payer relations staff to work care gap reports from Payers. Performs chart reviews and communicates with patient and/or Care team to close gaps and alerts providers when needed.
Provides a coordinated, strategic approach to detect early and manage effectively the chronically ill patient population.
Knowledgeable of clinical quality measures and preventive health maintenance recommendations. Educates patients, family members, and other staff members in these areas as needed.
Assists to establish a plan of care with patients, providers, and payers that identifies and continuously re-evaluates cost efficient, appropriate levels of care.
Understands and adheres to regulations for FQHCs and Primary Care Centers. Maintains a comprehensive working knowledge of community resources, payer requirements, and network services for target populations.
Understands population health and works collaboratively with the health care team to promote health and wellness.
Develops strong knowledge of our electronic medical record and the reporting capabilities.
Works intimately with IT staff and Patient Care Teams to improve quality outcomes.
Follows all organizational policies and procedures, including administrative, clinical, quality assurance, and personnel policies.
Maintains satisfactory attendance, including attendance at meetings and completion of assigned tasks.
Maintains timely documentation of all work assignments.
Maintains patient confidentiality.
Routinely keeps the supervisor informed regarding attendance and job assignments.
Demonstrates flexibility and the ability to multitask.
Works effectively and efficiently.
Works cooperatively with providers, administration, and peers.
Proactively acts as a patient advocate, responding with empathy and respect to resolve patient/family concerns.
Demonstrates continual learning skills, effects changes in approach to care based on established, evidence-based practice.
Uses motivational interviewing with patients/families/staff members.
Provides mentoring/coaching to other staff as needed.
Other duties as assigned by supervisor.