Care Manager Jobs

Job Summary

The Care Management Nurse's role is to coordinate continuity of care for patients and, as necessary, act as a liaison between the patient's family, provider and healthcare organization, supporting the proper course of treatment at the appropriate time to maximize health and well-being. Care Manager strives to promote self-managed care and the use of healthcare resources in the most cost-effective way possible, working with patients of all ages and conditions. The individual in this position is responsible for overseeing the clinical plan of care to conform to evidence-based practice and regulatory requirements. This position integrates care coordination, utilization management, and discharge planning.

We are a culture that is unabashedly driven by purpose. We are making a difference to our patients and providers while growing at an accelerated rate. Every day, we support the health journey of patients by authentically living our core values: Purpose Driven, Relationships Matter, Serve Others First, and Inspire Creativity. If you love serving others and would like to make a material difference in an industry-transforming organization, then we invite you to apply to this role. We are recognized as one of the Top 100 Places to Work by The Dallas Morning News, and we have been awarded as one of the fastest-growing privately held companies by SMU Cox.

Role And Responsibilities

• Promotes the mission, philosophy, goals, and policies of the organization through staff education.
• Assesses symptoms utilizing evidence-based tools to determine dispositions and comfort measures.
• Provides clinical oversight of the care plan and care coordination process implemented by the Care Coordinator.
• Develops and implements the care plan.
• Performs other duties as assigned
• Collaborates with providers and/or the Medical Director when appropriate (i.e., communicating review findings, criteria not met, use of alternative care settings, determining the appropriate level of care, delay of provision of services, etc.) ensure appropriate, coordinated service delivery.
• Identifies members appropriate for Care Management by using targeted chronic conditions, level of care, and recognition of member's disease-specific and preventative measures, knowledge base, or deficits in monitoring health, wellness, and chronic conditions. Reviews and analyzes clinical indicators and whether there is any 'gap' in compliance that will result in member contact.
• Completes clear and concise documentation in Care Management programs.
• Participates in departmental QIP process
• Monitors the care plan to determine if the goals are being met on an ongoing basis to evaluate for needed changes and updates the plan of care accordingly. Closes the plan of care when complete.
• Participates in the quality care conference program.
• Provides clinical oversight of the call coordination process initiated by the call coordinators
• Identifies and reports quality of care issues to the Medical Director and the VP of Medical Management.
• Conducts outbound calls to members to complete telephonic assessments and provide interventions and education to manage their health, wellness, and chronic conditions.
• Communicates and collaborates with Medical and Nursing staff.
• Maintain personal, professional development.
• An active participant in the Care Integration Platform
• Coordinates appropriate post-hospital services.
• Performs telephonic nursing assessments utilizing the nursing process.
• Collaborates with the Provider or their designee to address the care plan from an integrated approach.
• Collaborates with Medical Director when appropriate (i.e., communicates review findings, criteria not met, use of alternative care settings, determining the appropriate level of care, delay of provision of services, etc.) to ensure appropriate, coordinated service delivery.
• Identifies members requiring post-hospital services and initiates discharge planning with attending physician and designated hospital personnel.

Qualifications And Requirements

• Ability to handle multiple demands of diverse workload and prioritizes critical issues.
• Ability to utilize nursing skills to understand and coordinate the care of those significantly physically compromised by their illness and/or disability.
• Ability to analyze and think critically.
• 3+ years of various clinical experience.
• Accountable and autonomous.
• Computer literate
• Ability to effectively communicate verbally and in writing.
• RN license preferred
• Ability to maintain a HIPAA compliant professional work environment
• Ability to influence and effect change.
• CCM highly desirable
• Must maintain valid driver's license and vehicle.
• Good time management skills.
• Ability to build effective collegial relationships.
• Ability to quickly ascertain the severity of illness
• Able to develop, implement, communicate and evaluate a plan of care for each call
• Positive, service-oriented attitude.
• Must possess a current and active nursing license to practice in the state(s) assigned or maintain a compact license.
• Possesses current knowledge of disease pathophysiology, psychosocial issues, and treatment.
• High level of integrity.