CARE MANAGER | Care Management

Salina Regional Health Center

CARE MANAGER

POSITION SUMMARY
Coordinates the plan of care focusing on quality, timely delivery of services, and medical necessity of a patient's admission, including what level of care is appropriate. Assesses, plans, implements, monitors, and evaluates options and services to meet individual’s health care needs and the family systems that support the patient. Care Manager seeks positive health outcomes by ensuring well-orchestrated, coordinated care focused on quality, efficiency and safety. This position maintains an open, approachable manner treating others fairly and respectfully preserving self-confidence and dignity as well as show regard for their opinion(s).

POPULATION SERVED: Child, Adolescent, Adult, Geriatric
OSHA CATEGORY III

ESSENTIAL JOB FUNCTIONS

QUALITY
Performs comprehensive medical necessity reviews to determine appropriateness of care and anticipates Length of Stays.
Uses care management/physician model.
Assesses patient’s medical status, lab results, education needs, and formulates a plan to address assessed needs.
Collaborates with health care team & assists in the education of patient and families.
Implements actions to improve or resolve patients’ social or psychosocial problems.

ACCESS
Participates as a member of the multidisciplinary team using best practices in utilization review to monitor appropriateness of care and timely discharge of patients.
Participates in discharge planning, arranging for follow up care, and developing mechanisms for exchange of appropriate information with post discharge care providers.

STEWARDSHIP
Assures utilization compliance with payors, obtaining necessary authorizations.
Assists the director in monitoring all phases of documentation, delay(s) in treatment, discharge and denials.
Maintains knowledge of current reimbursement regulations.

ORGANIZATIONAL VALUES

PATIENT CENTERED
Keeps the welfare of the patient at the center of all decisions and actions by maintaining a customer-centered focus at all times.
Advocates for patients and their families by practicing behaviors that create a culture of patient focused activity.

QUALITY
Expects excellence of self and others.
Questions the status quo; uses creativity and innovation to engage in performance and process improvement.
Identifies and mitigates risk.

INTEGRITY
Is honest and ethical in all matters.
Demonstrates teamwork/cooperation within and across departments, understanding others perspectives and resolving conflict constructively.

TRUST
Safeguards the privacy, security, and confidentiality of protected health information at all times.
Treats all people with dignity; supports diversity; and understands related issues.
Is flexible and adaptable to change; demonstrates a positive and supportive attitude; and willingly accepts change.

SUSTAINABILITY
Holds self and others accountable in the use of SRHC supplies, and completion of tasks in a timely, efficient, and productive manner.
Volunteers for or accepts new or additional duties/responsibilities for the greater good of the department, organization, and/or patient.

POSITION QUALIFICATIONS

MINIMUM EDUCATION
Associate or Diploma Degree from an accredited registered nurse program

MINIMUM EXPERIENCE
Two years of acute care med/surg nursing experience

REQUIRED REGISTRATION/LICENSE/CERTIFICATION
Current Kansas Registered Nurse license
Applicable Resuscitation and other position-related certifications must be obtained within the timeframe established by SRHC policy.

PHYSICAL DEMANDS
Lifts, positions, pushes and/or transfers up to 20 pounds
Prolonged, extensive or considerable standing/walking
Considerable reaching, stooping, bending, kneeling, crouching
Manual dexterity and mobility
Near acuity: ability to see clearly at 20 inches or less

WORKING CONDITIONS
Exposed to unpleasant elements (accident, injury, illness, etc.)
Subject to varying and unpredictable situations
Subject to many interruptions; pressure due to multiple calls, inquires, and/or deadlines
Subject to irregular hours (days, evenings, weekends, holidays, on-call)

EMPLOYEE ACKNOWLEDGEMENT
In signing the job description, I attest that I will adhere to Salina Regional Health Center’s policies, procedures, and regulatory standards, including but not limited to complying fully with the Corporate Compliance Program and Code of Ethical Conduct; and participating actively in the Quality Assessment and Performance Improvement Plan, including identifying and mitigating risk to patients.

I acknowledge that I have read, understand, and accept the qualifications, responsibilities, and performance expectations outlined in the job description.  I recognize that these duties form the basis for my performance evaluations, and that management reserves the right to assign additional tasks or change existing essential job functions as operational needs dictate.  I confirm that I am able to perform the essential functions of this position with or without reasonable accommodation.