RN Lead Care Manager
Company: Complete Health
Location: Birmingham
Posted on: April 24, 2024
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Job Description:
SUMMARY OF JOB DUTIES:
Is your CV ready If so, and you are confident this is the role for
you, make sure to apply asap.
Under the direction of the Nurse Manager of Care Management, the
Lead Care Manager, RN is responsible for the overall performance of
the Chronic Care Management (CCM) and Transitional Care Management
(TCM) programs and staff in their assigned Care Pod(s).
The Lead Care Manager, RN provides clinical and administrative
oversight, support and training to their assigned Care Pod's staff,
which includes RN Care Manager(s), LPN Care Manager(s), Care
Coordinators and Patient Advocates. This position serves to assist
the Nurse Manager of Care Management in clinical oversight,
training, and documentation review. The Lead Care Manager, RN
assists the Nurse Manager of Care Management in efforts to
establish rapport with hospital-based case management departments,
skilled nursing rehab facilities, and home health agencies. The
role also assists with identifying and building relationships with
preferred specialty providers throughout an assigned geographic
area.
With collaboration of the primary care provider and the Nurse
Manager of Care Management, the Lead Care Manager, RN assists in
determining initial and subsequent patient acuity designations and
patient assignments to the appropriate Care Pod team member. He/she
oversees that each CCM patient receives a thorough assessment and
Care Plan initially, annually and as their condition requires and
that quality measures and gaps in care are being addressed by the
Care Pod Staff.
The Lead Care Manager, RN performs regular audits to ensure CCM
Care Pod staff accurately assesses and documents calls, cases,
updates Care Team and medication lists, closing quality gaps and
are bringing additional medical concerns to the primary care
provider. He/she regularly provides reports and feedback to the
Nurse Manager of Care Management for assigned Care Pod(s).
The Lead Care Manager, RN assists the Transitional Care Management
(TCM) team and assures TCM patients are followed by the appropriate
CCM staff as they transition from TCM to CCM. The Lead Care
Manager, RN may assign responsibilities to an RN, LPN, or other
well-experienced healthcare professional. However, their
performance and involvement must be closely monitored by the Lead
Care Manager, RN.
The Lead Care Manager, RN is responsible for triaging,
coordination, documentation, communication, and tracking of patient
calls, cases and records for a panel of high acuity Traditional
Medicare and Medicare Advantage Plan patients in the Chronic Care
Management (CCM) program as assigned by the Nurse Manager of Care
Management and is responsible for ensuring that patients with
chronic conditions in his/her care are provided with CCM services
in an appropriate and timely manner.
ESSENTIAL JOB FUNCTIONS:
Works closely with the Nurse Manager of Care Management, other CCM
team members, providers, clinical and Quality staff to help ensure
that the care patients receive is efficient, thorough, timely and
documented to help patients avoid ER and urgent care visits,
hospital admissions and readmissions. Assists in ensuring the best
quality of life possible for each patient in their care.
Provides and oversees regular communication and collaboration with
the patient's primary care provider, clinical staff, specialists
and outside care services for the benefit of the patient.
Facilitates and executes care management strategies for the care
coordination of CCM Patients, including utilization of other
population health initiatives, including communications with
patient's designated representatives and caregivers.
Works closely with the Quality Improvement Manager and team to
facilitate that Annual Wellness Visits are completed and gaps in
care and quality measures are met for the well-being of care
management patients.
Works with the Nurse Manager of Care Management and the Quality
Improvement Manager and the MSRs to identify specific patient
social and preventative care needs. Facilitates resolutions (when
possible) with resources throughout an assigned geographic
area.
Works closely with the Nurse Manager of Care Management to
determine initial and subsequent patient acuity designations and
assignments.
Provides CCM services to a high acuity panel of Traditional
Medicare and Medicare Advantage plan patients who are assigned to
his/her care.
Accurately assesses and documents opportunities for revision of
medication lists, addressing gaps in care and quality measures, and
brings additional medical concerns to the primary care provider as
needed for patient encounters.
Promotes and monitors regulatory practice standards and customer
service expectations for all aspects of nursing and patient care
pertaining to his/her Care Pod and within CCM and TCM
guidelines.
Monitors and maintains Time and Attendance for his/her Care Pod
Staff members.
Identifies staff development and training needs and ensures that
appropriate training is obtained.
Provides regular reporting of activities and statistical data to
the Nurse Manager of Care Management as directed.
Participates in pertinent meetings, conferences, workshops,
seminars, and related forums as requested.
Responsibilities include a rotating "on-call" schedule determined
by the RN Manager of Care Management.
Maintains current Registered Nursing License in the State of
Alabama.
Maintains confidentiality and follows HIPAA and OSHA Standards and
guidelines.
Maintains HR compliance and procedures.
Ensures patient satisfaction by providing excellent service,
putting Patients First Always.
Knowledge/Skills/Abilities:
The Lead Care Manager, RN must be able to perform each essential
duty satisfactorily. The characteristics listed are representative
of the knowledge, skill, and/or ability required.
Must have personal effectiveness and credibility, collaborative
skills, communication proficiency and flexibility. Must demonstrate
strong decision making and documentation skills.
Must be well-versed in knowledge of chronic health conditions,
acute care, behavioral health and substance abuse problems.
Excellent verbal, phone and written communication skills
required.
Able to work independently and in a multidisciplinary team.
Must be skilled in Interaction with respect and in a professional
manner with patients, staff and external customers. Demonstrates
ability to lead, instruct, direct and evaluate Care POD staff.
Responds to requests for service and assistance in a professional
and timely manner; meets commitments and is dependable.
Shows respect and sensitivity for cultural differences; educates
others on the value of diversity; promotes a harassment-free
environment.
Treats people with respect; keeps commitments; inspires the trust
of others; works with integrity and ethically.
Uses reason when dealing with emotional topics. Manages difficult
or emotional customer situations effectively, strives to
continuously build knowledge and skill.
Speaks clearly and persuasively in positive or negative situations;
Focuses on resolving conflict.
Possesses organizational and problem-solving skills; Identifies and
resolves problems in a timely manner; gathers and analyzes
information skillfully; develops alternative solutions in an
organized manner.
Provides regular reporting of data, activities and status of the
CCM patients in his/her care to the Nurse Manager of Care
Management as directed.
Knows, understands and works within the bounds or his/her scope of
practice. Seeks advise and/or help from management whenever needed.
Able to delegate responsibilities appropriate to staff licensure,
education, and experience.
Requirements:
MINIMUM REQUIREMENTS
Current Licensed Registered Nurse (RN), with a Bachelor's Degree
and 3 years of related care management, medical clinical experience
and/or training required; equivalent combination of education and
experience as determined by the Director of Quality and/or Practice
Administration.
Experience in social and care management services and patient
engagement is required. Knowledge of hospitals, specialists, and
ancillary health services throughout the assigned community is
preferred.
Strong computer skills and proficiency and knowledge of Microsoft
Office products and internet software is required. Able to
effectively utilize an electronic health record to perform and
document all patient encounters. Athena EHR experience
preferred.
Reasonable accommodations may be made to enable individuals with
disabilities to perform the essential functions.
WORKING ENVIRONMENT
The position requires climbing, stooping, kneeling, crouching,
reaching, standing, lifting, grasping, feeling, talking, hearing,
repetitive motions, and finger use. Pushing and pulling are
occasionally required. Use of a computer, keyboard, and telephone
along with various office machines is an essential part of the
job.
DISCLAIMER
The above statements are intended to describe the general nature
and level of work being performed by the Lead Care Manager, RN.
They are not to be construed as an exhaustive list of all
responsibilities, duties, and skills required of personnel so
classified. The Lead Care Manager, RN may be required to perform
duties outside of their normal responsibilities from time to time
as needed or as directed by supervision.
Keywords: Complete Health, Montgomery , RN Lead Care Manager, Executive , Birmingham, Alabama
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