RN Care Manager

The Stamford Hospital - Stamford, CT

Full-time - Mid Level

Stamford, CT

Hospitals

About the position

The Value Based Case Manager is responsible for collaborating with the Exec. Director of Care Management & Director of Quality to create & implement strategic plans for value-based care management programs. This includes coordinating the care and instituting appropriate interventions for high-risk patients with complex care needs. Assesses plans and evaluates the outcomes of care in collaboration with the other members of the health care team. Guides and collaborates with health care team members within the continuum to ensure quality and cost-effective care is given within a timely manner and an appropriate, safe post-acute plan has been facilitated. Focus on readmissions and interventions to improve transitions of care. Analyzes insurance payor patient data and translates this into work plans for case management and care gap fulfillment. Develops reports on the management of defined patient populations and discusses population management with members of the Stamford care team and leadership.

Responsibilities

• Works in conjunction with clinical teams and case management inside and outside of Stamford Health to coordinate complex patient care throughout the continuum of care.
• Collaborates with the Exec Director of Care Management & Director of Quality to create & implement strategic plans for value-based care management programs including the Anthem Connecticut State Employee program.
• Tracks & manages and reports on value-based care management program efficiency, cost & utilization measures.
• Participates in the development of budgets, health utilization measures, and financial measures.
• Tracks patient level performance & completes outreach to patients, practices & providers to facilitate higher quality & lower cost care for patients.
• Creates reports & presents regularly at meetings regarding program performance & outreach efforts to both internal and external audiences including senior leadership.
• Analyzes payor & internal data to target high risk, high cost and high utilizer patients of Stamford Health Medical Group and Stamford Hospital.
• Acts as a Super User for the organizational population health platforms & case management applications.
• Develops and participates in submission of reports to payers, regulatory agencies, foundations, and grant-making agencies.
• Collaborates with clinical teams, inpatient, and outpatient care management to develop plans for high risk and high-cost patients.
• Works with Quality Department to follow readmission data and trends.
• Participates in the Transitional Care Committee meetings (TCC).
• Provides ongoing assessment and case management of identified patient populations to ensure an accurate evaluation of patient needs.
• Maintains ongoing communication regarding patient care with physicians, referral sources, caregivers, and patients.
• Independently initiates assessments of situations and identifies and explores alternative care opportunities.
• Acts as an advocate for individual's health care needs and identifies barriers to timely care.
• Incorporates Social Determinants of Health issues into the plan of care.
• Responsible for maintaining a professional relationship with referral sources and community resources.
• May conduct visits in the field, home, skilled nursing facility, doctor's office, etc.
• Provides patients and families support and information about their current condition.
• Develops and supervises an assistant or analyst role as the program grows.
• Provides education and support to clinical staff regarding community resources.
• Demonstrates flexibility, organization, and functionality under stressful situations.
• Practices autonomously, consistent with evidenced-based standards.
• Performs other related duties as assigned.

Requirements

• Bachelors prepared Registered Nurse licensed in the state of Connecticut is required.
• Strong clinical experience in an acute care setting with additional experience in home care, long term care and case management is preferred.
• Professional certification in case management or clinical specialty is highly desirable.
• Experience in the area of value-based care programs, quality or Care Transitions is desirable.
• Strong analytical skills with the ability to interpret data and create strategic plans.
• Strong organizational and communication skills are essential.
• Completes required department and organization training and education in a timely manner.
• Demonstrates professional work behavior by following Stamford Health Standards for Service Excellence.
• Complies with departmental organizational policies and procedures.

Nice-to-haves

• Professional certification in case management or clinical specialty is highly desirable.
• Master's degree preferred.
• Prior case management, utilization management or discharge planning experience preferred.
• Prior experience with transitional care management strongly preferred.
• Experience with multi-aged and multicultural populations.

Benefits

• Competitive salary
• Comprehensive, low-cost health insurance plans available day one
• Wellness programs
• Paid Time Off accruals
• Tax deferred annuity and (403b) pension plan
• Tuition reimbursement
• Free on-site parking