Quality Care Manager - Remote in Indiana

divh2Quality Care Manager/h2pIndiana Health Centers, Inc. (IHC) is a mission-driven organization providing high-quality, affordable healthcare to underserved and uninsured populations since 1977. At IHC, a Federally Qualified Health Center, we specialize in integrated care which means having access to essential services to meet the needs of patients we serve in the community. With ten healthcare centers, eight Women, Infants, and Children (WIC) nutrition program locations, a Mobile Health Unit, and in-house Pharmacy services (select locations), we offer primary medical, dental, and behavioral healthcare services to community-based patient populations throughout Indiana that are diverse in age, educational background, and income level./ppIHC is now recruiting for a remote Quality Care Manager with RN or Dietician licensure in the state of Indiana. The Quality Care Manager facilitates communication between patients, their families, caregivers, providers, and other members of the healthcare team. Their focus is to offer individualized assistance to patients with complex disease states and multiple comorbidities, as well as their families and caregivers, to overcome healthcare system and community barriers and facilitate consistent and timely medical care across the continuum of care. The Quality Care Manager is an integral part of the Patient-Centered Medical Home and Patient Care Team./ppIHCs robust benefits and compensation package includes:/pulliDay 1 Insurance benefits eligibility/liliEmployer-paid Group Life, Short-term disability, and Long-term disability coverages, and HSA employer contributions/lili403(b) Retirement Plan matching at one year of employment/liliGenerous Paid Time Off and Floating Holidays/liliFlexible Leave of Absence programs/liliPersonify Health Wellness program with paid incentives for participation/liliEmployee Assistance Programs with 24/7 access to therapy consultation services/liliAnnual reimbursement for position-specific CMEs/CEs/liliStudent Loan repayment eligibility/li/ulpQuality Care Manager role responsibilities include:/ppOperations functions:/pulliIdentify high-risk patients using population health management tools (chronic conditions, ER utilization, SDOH, and referrals)./liliLink patient with resources based on SDOH assessment./liliProvide general clinical care coordination orientation to patients and communicate the goals and objectives of the program./liliProvide assistance for patients referred to/from providers, case managers, and from other points of entry./liliEvaluate patients deemed high risk by risk algorithm for care management and enroll patients who elect to participate./liliGuide patients through transitions of care from inpatient settings to home./liliContact patients to facilitate continuity of care and escalate issues to appropriate team members./liliAssist patients with adherence to existing self-management goals or development of new goals (in collaboration with practice clinical staff)./liliAssist in identifying individual and/or community needs which encourage healthy lifestyles and environments (i.e., community resources, transportation assistance, exercise programs, etc.)./liliInteract with the multidisciplinary team on behalf of the patient to resolve barriers. Communicate outcomes to patient/family/caregivers./liliMaintain timely and appropriate documentation on patient interactions in the care management system./liliProvide disease-specific and preventive care patient education per patient need./liliExecute effective interventions to reduce inappropriate ER visits or length of hospital to improve care and reduce costs./li/ulpQuality functions:/pulliAssist in the collection and assembly of quality improvement information for the purpose of tracking and trending./liliParticipate in cross-functional team meetings aimed at improving patient outcomes or operational processes./liliRegularly participate in care team huddles with care managers to identify priorities, tasks, and interventions./liliPerform population management activities as assigned./liliCompile and distribute educational material based on patient need./liliPerform follow-up activities with patients as needed after emergency department visits or inpatient discharges./liliAssist with scheduling medical and specialty appointments. Provide reminder phone calls for appointments and/or follow-up calls post appointment./liliRetrieve discharge summaries and copies of medical records./li/ulpRequired skills:/pulliExperience working with patients with complex chronic disease states and multiple comorbidities./liliDemonstrated knowledge and experience with the environment and systems through which patients must navigate./liliDemonstrated knowledge and experience in teaching/training patients./liliDemonstrated ability to develop and employ effective customer relationships with patients and health care team./liliAbility to assist in the facilitation and coordination of patient care plans./liliExcellent interpersonal communication and organization skills./liliAbility to work independently as well as on a team with a high variety of individuals./liliUtilize efficient time management skills./liliHigh degree of creativity in problem-solving./liliAbility and patience to navigate complex systems of care. Ability to communicate comfortably with multi-ethnic populations./liliStrong organizational skills./liliProficient in computer skills, including typing and use of Microsoft Word, Excel, Outlook, Access, eCW, SharePoint, Azara, etc./li/ulpRequirements:/pulliValid RN or Dietician license in the state of Indiana required./lili2 years general experience providing patient care in community or hospital setting./lili1 year care management experience or experience providing health education and outreach activities./liliCare coordinator certification preferred./li/ulpEqual Opportunity Employment Statement/ppWe are an equal opportunity employer. All applicants will be considered for employment without attention to race, color, religion, sex, sexual orientation, gender identity, national origin, veteran or disability status./p/div