Care Manager, RN

Description Summary / Objective: The Care Manager, RN acts in a non-caregiver capacity by facilitating coordination and communication between all members of the health care team in the decision making process to minimize fragmentation of the health care delivery system. As a member of the Care Management Department, this position is responsible for contributing to the standards of quality and service expected by both external and internal stakeholders, including ensuring accurate information flows to interdepartmental teams, proper documentation and adherence to standards related to case management activities. Essential Functions: • Exceed physician, provider and member expectations by providing professional and personalized service at all times. • Is aware of and continually supports strategic plans that ensure company objectives and goals are obtained. • Attends collaborative meetings with both internally and externally healthcare team members to support management services for clients served. • Builds and leverages cross-functional collaborative relationships to facilitate a team-work oriented atmosphere. • Assess clients for care management services after a referral has been made based on the admission screening and referrals for potential patient issues. • Develop and manage a coordinated plan of care to meet client and/or family needs • Assure that clients are placed on appropriate self-management plan and protocols, individualizes client care needs through consultation with the multidisciplinary team. • Coordinates services to support the appropriate care needs to promote best client outcomes and efficient use of healthcare resources. • Works with clients and providers to enhance the quality of client management and satisfaction. • Performs appropriate assessments and develops client-directed care plans within health plan required timeframes and per NCQA standards. • Assess need to involve medical director or primary care team when appropriate to assist with development of client-directed plan of care. • Regularly reviews and updates care plans for continuity of care and facilitates plan modifications including barriers to goals. • Coordinates with Non-Licensed Care Navigators to ensure appropriate follow-up with high risk clients to address identified goals and barriers. • Documents all interventions and telephone encounters with providers, members and vendors in accordance with established documentation standards. • Provide comprehensive training for new employees • Continues own education by keeping his/her knowledge current and conducts independent research of commercial plan guidelines to strengthen general understanding of state and federal resources to support position responsibilities. • Ensures compliance with departmental and PSW policies and procedures, with special emphasis on compliance with HIPAA privacy and security requirements and all state, federal and plan regulatory mandates. • Provides Transitional Care Management services post discharge from emergency room, acute inpatient or post-acute inpatient stays. • Follows Eric Coleman’s Pillars of Transitional Care to support reduced risk of adverse events following discharge. • Provides education on seeking medical attentional early or using urgent care services when appropriate versus an emergency room. • Follows the standards of care management services as outlined in the guideline manual updated no less than annually. • Provides telephonic engagements to clients on worklist to meet standards of engagement to include both timing, frequency, and duration of engagements. Knowledge/Skills/Abilities: • Set a positive example by displaying a pleasant and approachable demeanor and remaining friendly and courteous at all times. • Proactive team player, strong follow through, quick decision making abilities and ability to problem solve. • Interpersonal skills, with the ability to build strong relationships at all levels. • Strong verbal and written communication skills with customers, supervisors and co-workers. • Strong organizational, time management and prioritization skills: • Self-starter. Ability to set priorities and keep to projected schedules. • Excellent computer proficiency (MS Office – Word, Excel, Outlook ) including being able to effectively maintain written and computer records in accordance with regulatory agencies. • Familiarization and experience with Electronic Health Record systems Requirements Required Education and/or Work Experience: • Three (3) years of full proficiency clinical experience. • Verifiable experience or knowledge of a variety of clinical areas of medical treatment as related to general population and pediatric needs. • Knowledge and experience in providing care management and/or transitional care management services Preferred Education and/or Work Experience: • Bachelor’s degree from accredited school of nursing. • Case Manager Certification. • Experience with commercial health plans. Required Certificates, Licenses and Registrations: • Nursing degree (ie: RN) • Active unrestricted state license in State of Washington. *PSW does not typically hire at the top of the pay range * Summary Benefits: 401(k) 401(k) matching Dental insurance Disability insurance Flexible Spending Account (FSA) Health Savings Account (HSA) Health insurance Life insurance Paid time off Tuition reimbursement Vision insurance