Care Manager Job

Full Job Title: Care Manager

Job Number: 17007432

Facility: SSM Health Medical Group

Location: St. Charles County, MO

Schedule: Full Time, Days

Hours: 8 am - 5 pm

Description

Role Purpose:
Works under the supervision of the Director of Practice Management or Team Leaders. Serves in an expanded nursing role to collaborate with members and their Primary Care Providers to provide a model of care that ensures the delivery of quality, efficient, and cost-effective healthcare services. Assesses plans, implements, coordinates, monitors and evaluates all options and services with the goal of optimizing the member's health status. Integrates evidence-based clinical guidelines, preventive guidelines, protocols and other metrics in the development of treatment plans that are patient-centric, promoting quality and efficiency in the delivery of healthcare for the assigned patient population. Develops systems of care that monitor member progress and promote early intervention in acute care situations. Works effectively with other members of the health care team to optimize interventions. Manages utilization and practice metrics to further refine the delivery of care model to maximize clinical, quality, and fiscal outcomes for the Medicare and commercial population.
Responsibilities:
    • Works with Medical Group leadership in the design, implementation, and evaluation of the Medical Home care model.
    • Identifies the targeted population within his/her practice site and risk stratifies all members to prioritize needs and direct interventions.
    • Assesses the healthcare, educational and psychological needs of the member/family. Designs an individualized plan of care with the member and fosters a team approach by working collaboratively with the member, family, primary care provider, and other members of the health care team to ensure coordination of services.
    • Implements clinical interventions based on risk stratification and evidence-based clinical guideline adherence and promote best practice by initiating/adjusting therapies as directed by the practitioner and providing appropriate follow-up and monitoring as needed. Coordinates appropriate laboratory and diagnostic testing.
    • Coordinates referrals and other community resources.
    • Implements systems of care that facilitate close monitoring of high-risk members to prevent and/or intervene early during acute exacerbations.
    • Continuously evaluates laboratory results, diagnostic tests, utilization patterns and other metrics to monitor quality and efficiency results for assigned population.
    • Works closely with the practice care team and serves as a resource to the member and healthcare team.
    • Adheres to SSMHC Administrative standards regarding patient confidentiality.
    • Maintains required documentation for all care management activities. Collects required data and utilizes this data to adjust the treatment plan when indicated.
    Join our team for an online chat! There is no formal agenda, just jump online from your computer, smartphone or tablet to share your experiences, ask questions and learn about opportunities. It's as simple as texting with a friend.Click here to register today!Qualifications
    Minimum Requirements:
    • RN licensure or eligible for licensure in the state of Missouri required
    • 3 to 5 years of experience in clinical nursing, case management and managing Medicare patients required.
    • Critical thinking skills and the ability to analyze complex data sets required
    • General computer knowledge and the capability to use a computer required
    Preferred Qualifications:
    • Bachelor's degree in Health Care preferred
    • Case Management Certification preferred
SSM Health is an Equal Opportunity and Affirmative Action Employer. Qualified applicants are considered for employment without regard to race, color, religion, sex, national origin, age, disability, veteran status, sexual orientation, gender identity, or any other characteristic protected by law. Learn More »


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