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Care Manager

Company: HealthCare Partners
Location: Bradenton
Posted on: December 4, 2019

Job Description:

OVERVIEW OF POSITION: Responsible for ensuring the continuity of care in both the inpatient and outpatient setting utilizing the appropriate resources within the parameters of established contracts and patients health plan benefits. Facilitates continuum of patients care utilizing advanced nursing knowledge, experience and skills to ensure appropriate utilization of resources and patient quality outcomes. Performs care management functions on-site or telephonically as the need arises. Works in conjunction with the care team and PCP as care team leader. Ensures evaluation is in alignment with site based goals. ESSENTIAL FUNCTIONS: - Consistently exhibits behavior and communication skills that demonstrate DaVita Medical Groups Mission Vision and Values, and commitment to superior customer service, including quality and care and concern with each and every internal and external customer. - Represents the Company in a professional manner, following all Company policies and procedures. - Uses, protects, and discloses DaVita Medical Group patients protected health information (PHI) only in accordance with Health Insurance Portability and Accountability Act (HIPAA) standards. - Ability to obtain CPR certification within 90 days of employment (Basic Life Support for Healthcare providers (AHA) or CPR/AED for the Professional Rescuer (American Red Cross). - LPNs: Ability to obtain IV Certification within 90 days of employment. - Prioritizes patient care needs upon initial visit and addresses emerging issues. - Meets with patients, patients family and caregivers as needed to discuss care and treatment plan as delineated in Transitions of Care program. - Identifies and assists with the follow-up of high-risk patients in acute care settings, skilled nursing facilities, custodial and ambulatory settings. - Consults with physician and other team members to ensure that care plan is successfully implemented. - Coordinates treatment plans with the care team and triages interventions appropriate to the skill set of the team members. - Uses protocols and pathways in line with established disease management and care management programs and approved by medical management in order to optimize clinical outcomes. - Monitors and coaches patients using techniques of motivational interviewing and behavioral change to maximize self-management. - Oversees provisions for discharge from facilities including follow-up appointments, home health, social services, transportation, etc., in order to maintain continuity of care. - Works in coordination with the care team and demonstrates accountability with patient management and outcome. - Discusses Durable Power of Attorney (DPoA) and advanced directive status with PCP when applicable. - Maintains effective communication with the physicians, disease management, hospitalists, extended care facilities, patients and families. - Provides accurate information to patients and families regarding plan benefits, community resources, referrals and other related issues. - Documents pertinent patient information in Electronic Health Record and FOCUS as appropriate. - Demonstrates a thorough understanding of the cost consequences resulting from Care Management decisions through utilization of reports and systems such as Health Plan Benefits, utilization of metrics and CM reports. - Adheres to departmental policies and procedures as approved by Best Practice Committee and QMOC (Quality Medical Oversight Committee). - Ability to work collaboratively with the provider and care team to carry out nursing interventions under proper scope of practice. - Performs additional duties as assigned. - Ability to travel as necessary, or cover centers remotely, based on business need. EDUCATION: - High school graduate, GED or equivalent. - Graduation from an accredited school of Nursing. - Must possess a current and valid LPN or RN Florida state license. - LPNs: IV Certification required. - RNs: Associates or Bachelors degree in Science required. - Basic Life Support for Healthcare providers (AHA) or CPR/AED for the Professional Rescuer (American Red Cross). EXPERIENCE: Minimum: - Previous experience in an acute clinical care setting or equivalent. - Previous care management, utilization review or discharge planning experience. Preferred: - One year experience in an acute clinical care setting preferred. - Bachelors degree in Nursing preferred. - HMO experience preferred. KNOWLEDGE, SKILLS, ABILITIES: - Knowledge of current standards of patient care. - Thorough understanding of RN scope of practice and LPN scope of practice. - Ability to provide on-site clinical treatment within scope of practice. - Ability to perform accurate telephonic triages, accurately record findings with follow-up. - Knowledge and skill in the applications of the techniques and practices of the nursing profession. - Ability to explain medical instructions to patients and their families. - Ability to make sound, independent judgments and act professionally under pressure. - Valid Florida drivers license, insurance and vehicle for work-related travel. - Ability to learn and understand appropriate Federal, State, and local regulations. - Ability to effectively communicate and collaborate with physicians, patients, families and ancillary staff. - Ability to communicate effectively with patients and all levels of personnel/customers in a professional, courteous and effective manner using excellent customer service skills. - Ability to be a clinical resource for non-licensed office staff. - Ability to prioritize and multi- task in a high paced environment with good organizational skills. - Display initiative, accountability and resourcefulness. - Ability to perform care management. - Must be computer literate. - Knowledge of HIPAA regulations. - Ability to read, speak, write, and understand the English language fluently. What's the first thing that happens when one of the leading independent medical groups in the country comes together with a global leader in health care? Opportunity. With DaVita Medical Group, HealthCare Partners, The Everett Clinic, Northwest Physicians Network, MountainView Medical Group and Magan Medical Clinic joining OptumCare and the UnitedHealth Group family of companies, people like you will find increasing levels of challenge, impact and professional success. We're changing health care for the better by improving access to affordable, high quality care, and working together to improve the patient experience. That takes passion, commitment, intense focus and the ability to contribute effectively in a highly collaborative team environment. Are you with us? Learn more about this exciting opportunity to do your life's best work. (SM) Careers with OptumCare. Here's the idea. We built an entire organization around one giant objective; make the health system work better for everyone. So when it comes to how we use the world's large accumulation of health - related information, or guide health and lifestyle choices or manage pharmacy benefits for millions, our first goal is to leap beyond the status quo and uncover new ways to serve. OptumCare, part of the UnitedHealth Group family of businesses, brings together some of the greatest minds and most advanced ideas on where health care has to go in order to reach its fullest potential. For you, that means working on high performance teams against sophisticated challenges that matter. Here youll find incredible ideas in one incredible company and a singular opportunity to do your life's best work. (SM ) Diversity creates a healthier atmosphere: OptumCare and its affiliated medical practices are Equal Employment Opportunity/Affirmative Action employers and all qualified applicants will receive consideration for employment without regard to race, color, religion, sex, age, national origin, protected veteran status, disability status, sexual orientation, gender identity or expression, marital status, genetic information, or any other characteristic protected by law. OptumCare and its affiliated medical practices is a drug-free workplace. Candidates are required to pass a drug test before beginning employment.

Keywords: HealthCare Partners, Bradenton , Care Manager, Executive , Bradenton, Florida

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