Care Manager

General Summary The Care Manager is accountable and responsible for coordinating the care and services of the assigned patient populations.
The care manager promotes effective utilization and monitoring of health care resources and ensures appropriate placement across the continuum.
The care manager assumes a leadership role with the Interdisciplinary Care Team (IDC) to achieve optimal clinical, financial and resource outcomes.
Essential Duties and Responsibilities Promotes effective utilization and monitoring of health care resources.
Ensures appropriate placement across the continuum.
Assumes a leadership role with the Multidisciplinary Care Team (MDC) to achieve optimal clinical, financial and resource outcomes.
Collaborates with physicians and makes appropriate recommendations regarding medical necessity for admission, continued stay, or alternative treatment facilities, agencies, and/or resources.
Contributes to the development of a goal directed plan of care that is prioritized and based on determined medical diagnosis, patient problems, co-morbidities, and expected patient outcomes.
Evaluates effectiveness of care and systems relating to the patient’s progress toward goals and outcomes and acts as an active participant in the patients’ and significant others’ educational process.
Completes the discharge planning evaluation in a timely manner.
Coordinates and communicates, in timely manner, the discharge plan with the patients, significant others, and providers of care.
Communicates directly with patients, significant others, and providers of care during the denial process to include issuing denial letters and assisting in appealing hospital denials prior to and after the discharge of a patient.
Provides and coordinates patient and family discharge plans based on the age of patient.
Applies knowledge of growth and development, ranges of treatment, and by obtaining and interpreting information regarding patient needs.
Job Qualifications Education Graduate of an accredited School of Nursing or Social Work.
Bachelor’s in Nursing or Bachelor’s in Social Work preferred.
Work Experience Two years of clinical experience required.
Three years of clinical experience preferred.
Experience with utilization management, discharge planning, and third party payors preferred.
Must be computer literate and have knowledge and understanding of psycho/social needs.
Certification/License Missouri or Compact RN license, if applicable.
Case Management certification preferred.
Mental/Physical Requirements Considerable mental concentration required.
Lifting up to 35 lbs.
, turning activities and nearly constant walking required.
Standing, turning, carrying, pushing, pulling, stooping, crouching, twisting, and reaching.
Working Conditions Frequent exposure to infectious disease and hostile persons at times.
Frequent exposure to communicable disease via blood and other body fluids.
Minimal physical discomfort.
Location: Phelps Health · Care Management Schedule: Full-time, Day shift, M-F 8-4:30 with rotating weekends; cross train to Emergency Dpt Care management 7a-7P hrs.