care manager prn
Company: Christus Health
Location: Tyler
Posted on: October 5, 2024
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Job Description:
Summary:
The Care Manager (CM) PRN works in collaboration with the
patient/family, physicians, and multidisciplinary team members to
ensure patient progression through the continuum of care and to
develop a plan of care for each assigned patient from admission
through discharge. The CM is responsible for identifying,
initiating, and managing optimal patient flow/throughput to enhance
continuity of care, smooth and safe transitions, patient
satisfaction, patient safety, and length of stay management.
Support and expertise are provided through comprehensive
assessment, planning, implementation, and overall evaluation of
individual patient needs. Care Coordination and Discharge Planning
are both responsibilities of this role. The CM assesses and
responds to patient/family needs by coordinating the efforts of
other team members and identifies and resolves barriers that hinder
effective patient care. The CM adheres to departmental and
organizational goals, objectives, standards of performance,
policies, and procedures, and continually assures regulatory
compliance.
Responsibilities:
--- Meets expectations of the applicable OneCHRISTUS Competencies:
Leader of Self, Leader of Others, or Leader of Leaders.
--- Interviews patients/families to obtain information about
social, emotional, and financial factors which may impact health
status both prior to, and after, discharge and assess the patient's
current formal and informal support system as well as available
benefits and resources.
--- Works with the CMII or CMIII to develop and monitor the
patient's plan of care to ensure effectiveness and appropriateness
of services.
--- Coordinates/facilitates patient care progression throughout the
continuum of care in an efficient and cost-effective manner.
--- Serves as resource, provides support, and acts as an advocate
on behalf of the patient related to treatment decisions and end of
life issues.
--- Closely monitors patient length of stay and
communicates/collaborates with appropriate interdisciplinary team
members to remove barriers and expedite discharge.
--- Identifies and escalates local and system barriers that are
impeding diagnostic or treatment progress and issues related to
quality and risk as appropriate in a timely manner.
--- Works to resolve identified delays to discharge.
--- Collaborates with medical staff, nursing staff, and ancillary
staff to eliminate barriers to efficient delivery of care in the
appropriate setting.
--- Assesses needs for discharge planning and continuing
care/resource support following discharge; independently makes
recommendations to patients and families regarding post-acute level
of care needs and options including:
--- Acute Rehabilitation Placement
--- Nursing Home or Skilled Nursing placement
--- Psychiatric or Substance Abuse placement
--- New Dialysis
--- Child/Adult/Domestic Abuse
--- Home Health/Hospice Referrals
--- Legal issues (adoptions, guardianship)
--- Assistance with Advance Directives
--- Community Resource needs
--- Financial Issues/Funding options
--- DME Referrals and Coordination
--- Social Determinants of Health
--- Ensures appropriate communication and updates are provided to
the patient/family and members of the healthcare team and are
documented as necessary to assure continuity of care.
--- Provide appropriate interventions which demonstrate knowledge
of and sensitivity toward cultural diversity and the religious,
developmental, health literacy, and educational backgrounds of the
patient population.
--- Provides information and support to patients and families,
helping them access needed resources within the medical center and
community.
--- Ensures and maintains plan consensus from patient/family,
physician, and payor.
--- Collaborates with the physician and other health care
professionals to promote appropriate use of medical center
resources.
--- Actively participates in Multidisciplinary/Patient Care
Progression Rounds.
--- Escalates cases as appropriate and per policy to Physician
Advisors and/or CM Director.
--- Documents in the medical record per regulatory and department
guidelines.
--- Assumes responsibility for professional growth and
development.
--- Must have excellent verbal and written communication and
ability to interact with diverse populations.
--- Must have critical and analytical thinking skills.
--- Must have demonstrated clinical competency.
--- Must have ability to Multitask and to function in a stressful
and fast paced environment.
--- Must have working knowledge of discharge planning, utilization
management, case management, performance improvement, and managed
care reimbursement.
--- Must have understanding of pre-acute and post-acute levels of
care and community resources.
--- Must have ability to work independently and exercise sound
judgment in interactions with physicians, payors, patients and
their families.
--- Must have understanding of internal and external resources and
knowledge of available community resources.
--- Must have the ability to move around the hospital to all areas
for the majority of the workday while in office the rest of the
day; general office and hospital environment.
Requirements:
Work Schedule:
TBD
Work Type:
Per Diem As Needed
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Keywords: Christus Health, Rowlett , care manager prn, Executive , Tyler, Texas
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