Care Manager Registered Nurse (RN) - Case Management Division (Hybrid)

Department:

39730 Accountable Care Admin - AdvocateCare O/P Case Management Division

Status:

Full time

Benefits Eligible:

Yes

Hours Per Week:

40

Schedule Details/Additional Information:

DEPARTMENT/OPERATING HOURS:

Monday - Friday; 8:00am to 8:00pm.

RN HOURS:

Monday - Friday; 8:00am - 4:30pm ( hours may fluctuate based on Care Managers assignment)

The ACM department focus is to assist high risk patients manage uncontrolled conditions while keeping them out of the hospital. We work with a delegated group of patients and are required to meet NCQA audit guidelines.

Hybrid position

2 days a week at practice; AMG Southeast Clinic, 2301 East 93rd St. Chicago, IL. 60617

3 days remote from home

New Care Manager must:

• Be licensed in IL

• Have high speed internet at home

• Have a private office at home

• 1-2 years of Care Management experience or 5 years of experience in clinical nursing

Uses the nursing process with at-risk patients to assess, plan, implement and evaluate clinical strategies leading to quality results, optimal cost/utilization, and patient experience. Works across the care continuum to support patients in addressing the following dimensions of care: clinical management, education/knowledge, psychosocial needs, self-management, advocacy, and continuity of care. Establishes an ongoing, therapeutic relationship with the patient/family to improve access, reduce burden of disease, manage care transitions, and increase use of appropriate access points of care.

Major Responsibilities:

• Facilitates communications among patient/family, multidisciplinary team, medical management team, community resources and other disciplines to anticipate, identify, evaluate, and act to resolve any potential barriers and constraints to delivery of care in a timely manner. Understands and interprets multiple contracts and contractual obligations to enable the care management team to achieve maximum clinical and financial outcomes.
• Collaborates with the patient/family and inter-professional team including the primary care team, hospital care team, post-acute care managers, and other care partners to provide a model of care that ensures the delivery of quality, efficient, and cost-effective healthcare services. May work embedded within a provider office or telephonically working with a care team.
• Uses evidenced-based approaches to increase patient and family activation and engagement in their own care. As appropriate to the population, partners with patient and family to develop SMART (specific, measurable, attainable, relevant, time-bound) goals. Assists in the development, procurement, and adoption of patient self-management educational resources.
• Identifies potential barriers to learning and/or to the optimal delivery of care. Reports abnormal findings to the responsible provider/care team and collaborates to develop a plan.
• Independently manages CM caseload according to department expectations. Ensures timely completion of tasks and documentation related to MCO, regulatory and contractual requirements.
• Partners with identified at-risk patients throughout the diagnosis, treatment and follow-up in order to deliver continuity of care. Anticipates the needs of the patient, recognizes and responds to changes in a patient’s status and determines priorities of patient care based on essential patient needs.
• Coordinates patient information and communication between and among the patient/family, the referring/accepting facilities and physicians, community caregivers (as applicable) and other members of ACM to ensure smooth transitions of care.
• Coordinates referrals to other internal AAH departments and/or external community resources as necessary.

Licensure, Registration, and/or Certification Required:

• Registered Nurse license issued by the state in which the team member practices.

Education Required:

• Bachelor's Degree in Nursing or related field.<