Case Manager

Care Manager

Saint Joseph, MO, United States (On-site)

Job Description

The Care Manager works under the supervision of leadership providing coordination of care for patients in Mosaic Life Care and the organization's service area in such a manner as to use the right resources, at the right time and at the right level of care. Utilizing a collaborative process, the Care Manager will assess, plan, implement and evaluate the options and services required to meet an individual's health and health related needs. Strong communication skills are necessary to access available resources and communicate with providers and other members of the interdisciplinary team. The Care Manager serves as an advocate for the patient, family and the organization to promote quality, cost effective outcomes. Active participation in program development and process improvement efforts is an expectation of the role of Care Manager.

Responsibilities

• Proactively identifies patients/individuals appropriate for CM service based upon indicators of each program (i.e. Utilization data, Quality data, Clinical indicators, etc) utilizing electronic tools, reports, and interview techniques effectively/efficiently to gather information about assigned populations and prioritizes workload appropriately to meet desired outcomes.
• Responds to referral requests in a timely manner and offers possible alternatives for assistance if referral is not appropriate for CM intervention.
• Collects and reviews information to determine strengths and barriers of the patient in 6 key areas: access to care, current problems/treatment plans (medical/mental health), psychosocial/support system (formal and informal resources), functional status/safety, financial/benefits available, lifestyle/behavior (risk factors).
• Develops a plan to address identified barriers to care collaboratively with the patient/family, provider and interdisciplinary team. Prioritizes the plan appropriately to achieve optimal outcomes (Quality, Cost, Experience) avoiding a focus on task accomplishment.
• Coordinates/facilitates implementation of plan demonstrating problem solving skills, effective communication and appropriate sense of urgency in providing service to avoid delays in progression of care, and over, under, or inappropriate utilization of resources (include but not limited to unnecessary ED/IP visits, greater than expected LOS, unplanned readmissions, unnecessary testing/treatment, etc.).
• Monitors effectiveness of CM services through patient reassessment and outcome analysis and revises plan as necessary. Compiles tracking reports/summaries as requested for measure and/or productivity purposes.
• Effectively communicates the goals and processes of assigned program to various audiences. Communicates effectively with internal and external customers the benefits of Care management service, programs, and process for referral.
• Develops and maintains knowledge of Medicare, Medicaid and key payer benefits/reimbursement methodologies necessary to procure services for patients and serve as a resource to the IDT on quality, cost effective care.
• Maintains understanding of, and articulates the Regulatory requirements (CMS, TJC, etc) regarding Discharge Planning/Utilization Review and/or Care Management services.
• Maintains a patient centered approach through ongoing communication with patient/family seeking their input and participation at all times.
• Bed Side rounding with inter disciplinary team
• Other duties as assigned

Education

• Graduate from school of nursing. - Required
• BSN - Preferred

Work Experience

• 3 Years - Clinical experience, Care Management - Preferred
• 3 Years - Clinical experience in a Behavioral Health related field for Behavioral health care manager - Preferred
• 3 Years - Clinical experience in clinical field (obstetrical nursing) for Pregnancy Care Manager - Preferred
• 3 Years - Experience navigating resources and computer systems to access information. - Required

Licenses and Certifications

• Registered Nurse (RN) - State Licensure/Or Compact State Licensure - Licensed in State of Missouri and Kansas (as needed for job assignment) - Required Upon Hire
• Basic Life Support (BLS) - Required within 90 Days

Travel Requirements

• Must be able to travel between various system facilities and off-site locations as needed. - No

About Us

Mosaic Life Care is a health care system in northwest Missouri. With a vision of transforming community health by being a life-care innovator, Mosaic places the holistic needs of patients first by providing the right care at the right time and place, offering high value and quality health care. Mosaic has a wide array of benefits to meet each employee's individual needs. Our benefits were designed by listening to people just like you. Mosaic also offers several perks with a focus on ensuring our employees feel valued, including concierge services, employee lounge, wellness programs, free covered parking, free on-site and virtual health clinics and many more. When paired with compensation and recognition, it is what continues to make us the employer of choice for employees at any stage of their journey.