GENESIS HEALTHCARE SYSTEM
 

In order to fill our Mission of serving our community by helping each person achieve optimal health and well-being by providing compassionate, exceptional, and affordable healthcare services, all employees of Genesis HealthCare System must be committed to living the Genesis Mission and Genesis values of Compassion, Excellence, Integrity, Team, and Innovation. All employees must regard themselves as an ‘owner’ of Genesis and keep our patients at the center of everything we do - always. 

Position Details:

Work Shift:

Day Shift (United States of America)

Scheduled Weekly Hours:

40

Department:

Heart Lung & Vascular Zanesville

Overview of Position:

The
Care Management Consultant functions within the full scope of nursing practice
to ultimately assist patients through the healthcare system by acting as a
patient advocate and navigator.

The
Care Management Consultant creates longitudinal personalized care plans for
patients, collaborates with and coordinates the efforts of providers across the
continuum and increasingly uses data analytics to manage the health of
populations.;

ESSENTIAL DUTIES

1.  Transitional and longitudinal care planning and execution

• Conducts assessments of patient/family needs by coordinating input from all health professionals and formulating a documented plan assuring continuity of care for the highest risk patients
• Coordinates continuity of patient care with patients and families following hospital admission, discharge and ER visits
• Delegates care based on situation while assuming accountability for patient outcome. Supports assistive personnel; serves as a resource and holds assistive personnel accountable to complete delegated tasks
• Along with physician hospitalists/PCPs/APPs/specialists, leads and coordinates activities of interdisciplinary treatment team required to make high risk clinical, benefit and network decisions

2.  Communication and coordination between care settings

• Identifies appropriate providers, facilities, external healthcare organizations throughout the continuum of care and communicates with an interdisciplinary treatment team to develop and maintain positive working relationships with patients, families and providers
• Functions as a coordinator and manager of a defined health population across multiple care settings and for multiple physicians/health care providers or health plan counterparts
• Coordinates care across the continuum (inpatient/outpatient/community) to assure appropriate utilization of clinical and community resources
• Works collaboratively with primary care practices to offer individualized assistance with improving and maintaining quality patient care
• Guides development of multiple health care partnerships to achieve a positive health effect
• Ensures that transitions of care are completed for his/her assigned patients, and that patient has the appropriate resources to improve care outcomes and prevent readmissions.  Explains system wide care management to their patients and ensures that they know how to reach them when they have questions or concerns.  Considers the patient’s goals and preferences when developing the patient’s system wide care plan. 

3.  Utilization management and data analytics

• Manages high risk patient care, including management of patients with multiple co-morbidities or high risk for readmission to a hospital setting, using a patient registry when appropriate
• Participates in data collection, health outcomes reporting, clinical audits and programmatic evaluation as needed
• Analyzes data to identify under/over utilization; improve resources consumption; promotes potential reduction in cost; and enhances quality of care consistent with organization strategic goals and objectives. Data includes but is not limited to predictive analysis, risk stratification, cost-benefit analyses, financial analyses; clinical outcomes; utilization and practice patterns
• Assist with on-going review / readmission root cause analysis and action plan development associated with your assigned population of patients.

4.  Skills Required

• Excellent communication skills (oral and written)
• Excellent customer service skills
• Proven leadership skills
• Ability to work independently, setting priorities to coordinate care plan efficiently
• Ability to work effectively in a team environment
• Highly organized and detail-oriented
• Ability to perform multiple tasks
• Effective behavioral and educational strategies, including b