Utilizes RN process as a framework to focus the activities of the healthcare team on the achievement of optimal outcomes, resource utilization, clinical expertise, and improvement strategies. Interacts with patients, professionals, and the community to achieve continuity of care, coordination of services and to document plans of care across multiple care settings. Conducts or participates in comprehensive “all-system” needs assessment for identified patients; knowledgeable of appropriate care-related services to match identified needs disease management for health maintenance, and appropriate clinical goal expectations/outcomes for identified population. Develops and maintains accurate case records of each referred customer/patient. Documents fully and accurately; knowledgeable of and utilizes accurate computer databases and documentation systems. Maintains knowledge of various reimbursement criteria and documentation necessary for reimbursement, including Medicaid, Medicare, and Managed Care. Demonstrates leadership in the professional practice of nursing evaluating his or her own nursing practice in relation to professional practice standards and guidelines, relevant statues, rules and regulations. Facilitates a lifelong, proactive partnership with patients to enhance and personalize management of health-related needs. The Care Manager assesses needs, plans, coordinates, and evaluates services of patients with the goal of equipping and empowering individuals and their families to easily access resources and adopt healthy lifestyles that will increase their ability to remain in the most appropriate care setting. Care Managers focus on five primary areas: 1) population management, 2) patient self-management support, 3) transitions in care, 4) resource connection, and 5) appropriate resource utilization. Works collaboratively and maintains active communication with the multidisciplinary care team including providers, pharmacists, social workers, behavioral health specialists, and nurses to achieve timely, appropriate patient management.
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Job Type
Part-time
Number of Employees
5,001-10,000 employees