Case Manager Specialist- Care Management
Company: Legacy Health
Location: Gresham
Posted on: February 1, 2025
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Job Description:
Case Manager Specialist- Care ManagementUS-OR-GRESHAMJob ID:
24-40942Type: On-Call (10% Differential and Min Shift Availability
Required)Mount Hood Medical Center campusOverviewThe Case Manager:
Coordinates and facilitates interdisciplinary provision of
comprehensive, patient-centered, quality health care throughout the
continuum for patients with acute and chronic health conditions.
Fosters achievement of optimal health care outcomes within accepted
standards of care. Serves as an expert resource to the healthcare
team regarding the continuum of care, efficient use of resources,
Best Practice protocols, team-based care, quality indicators and
improvements, and regulatory requirements. Ensures a smooth
transition of care between multiple health care environments with
planned handoffs. Partners with patients and families in
identifying health care issues and barriers to self-care in order
to set priorities and engage in appropriate interventions.
Demonstrates cultural agility and employs health literacy
guidelines to provide education regarding self-management
strategies. Utilizes rapid quality improvement cycles to
continuously monitor, evaluate, measure, and report progress of
interventions and outcomes. Paces the case to assure appropriate
and fiscally sound care coordination across the continuum.Legacy
Mount Hood Medical Center is East County's full-service hospital,
always expanding to meet the community's growing needs and offering
an award winning patient experience delivered with a personal
touch. We offer advanced imaging, a modern emergencydepartment, a
welcoming family birth center, surgical services, intensive care,
cancer care, gastroenterology and more. ResponsibilitiesFacilitates
daily multidisciplinary care coordination meetings to clarify
patient plan of care. Communicates with patients and their families
concerning the progress of patient recovery goals and ongoing care
needs. Organizes and/or participates in patient care
conferences.Coordinates care and expected outcomes between
patients/families and healthcare team including nurses, social
workers, physicians, therapists, and community agencies and
resources.Develops and maintains a collaborative working
relationship with all team members. Follows evidence-based best
practice. Serves as the clinical resource manager for patients with
complex care needs. Provides consultations for patients who do not
follow or have multiple variances from a pre-established clinical
path. Assesses patient care priorities with patient and staff as
part of the health care team and participates in determining
outcomes of interventions.Collaborates with patient, family, and
other health care professionals in the establishment of goals and
implementation of patient plan of care.Facilitates referrals,
multidisciplinary review and planning for specific
patients.Maintains currency in case management practice and
principles specific to venue.Ensures transition plan reflects
national guidelines and/or approved protocols/pathways.Maintains
knowledge of professional standards of practice through
participation in continuing education, community and professional
activities, and committee membership.Assists patient care team to
identify and coordinate appropriate level of care across the health
care continuum.Focuses on promoting early intervention for complex
patients and communicating a coordinated plan of care to prevent
unnecessary complications and negative patient
outcomes.Communicates with UM RN(s) and with insurance and
community case managers, when appropriate, to discuss benefits and
obtain authorization for alternative level of care. Assists health
care team to incorporate the educational needs of patients and/or
families concerning alterations in health and the disease process
into the plan of care.Assists with patient and family education as
appropriate and necessary.Collaborates with Legacy leadership to
identify educational needs of staff.Participates in and/or leads
committees and task forces.Participates in identifying needs and
developing programs which facilitate attainment of organizational
goals.Represents applicable clinical areas in the review and
development of hospital and overall system policies, procedures,
protocols, guidelines, and standards.Participates in Continuous
Quality Improvement (CQI) activities.Participates in data
collection, analysis and reporting of defined indicators to
facilitate comprehensive evaluation of program impact. Collaborates
with Legacy management team and staff in developing and utilizing
quality indicators to monitor and evaluate care and
outcomes.Participates as an active member in department meetings
and group problem-solving sessions. Sponsors changes to improve
department operations and supports others' suggestions for
change.In setting professional goals, includes attainment of case
management certification. QualificationsEducation:Academic degree
in nursing (BSN or higher) preferred. Experience:This position
requires extensive knowledge of disease management to include
diagnostics, treatment and prognosis, community resources and
healthcare reimbursement. Minimum 2 years clinical nursing
experience required. Relevant experience in one or more of the
following healthcare areas preferred:Coordination of community
resourcesCare management of diverse patient populationsAmbulatory
Care Knowledge of levels of care throughout the health care
continuum to include; inpatient, emergency care, rehab, home
health, hospice, long term acute care, SNF, ICF, ALF with an
overall understanding of utilization management and resource
management.Working knowledge of Care Management models across the
continuum. Knowledge/Skills:Knowledge of six core components of
case management:Psychosocial aspectsHealthcare
reimbursementRehabilitationHealthcare management and
deliveryPrinciples of practice i.e. CMS guidelines, Interqual
criteriaCase Management conceptsExcellent organizational
skillsHealth literate oral and written communication skills for
effective interaction with all members of the patient's health care
teamKnowledge of transitional planning to and from all
venuesAbility to determine and access appropriate community
resourcesAbility to engage patient/family in discussion of health
care goals and decisions with attention to cultural and health
literacy implicationsAbility to adhere to and implement regulations
in an effective manner. Must serve as a resource to all team
members regarding regulatory issues.Keyboard skills and ability to
navigate electronic systems applicable to job functions. LEGACY'S
VALUES IN ACTION:Follows guidelines set forth in Legacy's Values in
Action. Equal Opportunity Employer/Vet/Disabled Compensation
details: 50.57-75.55 Hourly WagePI50aa6756d243-25660-36057180
Keywords: Legacy Health, Gresham , Case Manager Specialist- Care Management, Executive , Gresham, Oregon
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