Care Manager (RN)

Employer
MultiCare
Location
Puyallup, WA
Salary
Competitive
Posted
Jan 17, 2020
Closes
Feb 06, 2020
Specialty
Managed Care
Contract Type
Permanent
Hours
Full Time
The RN Personal Health Partner (PHP) is responsible for exemplary cross continuum care coordination. This individual works with physicians, peers, community colleagues, and others to orchestrate care across the health care continuum, to identify opportunities to continually improve patient care and services, to improve population health, and to achieve collaborative practices that exemplify MultiCare Health Systems commitment to patient centered care and community engagement.

EDUCATION & EXPERIENCE
BSN or Associates Degree in Nursing with other Bachelors degree
3 years of recent clinical hospital/ambulatory experience
RN, licensed in the State of Washington
Healthcare financial and reimbursement knowledge preferred
Leadership and emergency services experience a plus

PRINCIPAL ACCOUNTABILITIES
Conduct
Ensures that the divisions mission, vision, and values are actualized
Provides exemplary customer service to the patient, family, physician, and care team members
Models and orchestrates consistent, professional communications and maintains consistent and proactive communication patterns with colleagues and staff
Establishes rapport and relationships with hospital staff and leaders, community physicians, physician practices, and post acute providers
Highly visible within MultiCare Health System (MHS) facilities and the market
Responds positively to change
Delegates responsibilities appropriately, but remains accountable for outcomes
Patient and Family
Ensures that the patient and family experiences seamless and safe transitions of care
Ensures that patient and family engagement are an integral and essential component of the care delivery process
Advocates for patients and families
Ensures face-to-face communication with the patient and/or family within 24 hours of admission to the hospital, to introduce the role of the PHP and to initiate the transition of care plan, or as soon as medically appropriate in other sites of care, such as the emergency department, outpatient bed, urgent care or community care facility
Engages the patient, family, and physician and staff, in development of a post acute plan of care, and/or, a health maintenance and health promotion plan of care
Visits each patient daily, while in the hospital
Provides pertinent patient and family education consistent with MHS Transitions of Care standards
Develops patient self management goals and monitors the progress of the goals
Ensures that patients and families receive education on health and wellness activities, disease process and interventions, next steps, and other critical factors in overall health maintenance and improvement
Physicians
Partners with and supports physicians in patient care activities and care transitions
Supports physicians in navigating the complex challenges of compliance and cost effective care
Serves as a resource for physicians on health industry trends, rules, regulations, reimbursement, denial management and avoidable days, clinical cost reduction, etc.
Collaborates with physician(s) to set daily rounding times or meetings based on the physician schedule and what is best for the patient
Participates in, and contributes to, daily physician rounding
Engages physician partners in care improvement and resource management activities
Community
Develops significant market savvy, ensuring that services and interventions address the needs of the market demographic, and are sensitive to cultural and ethnic practices and beliefs
Establishes significant functional relationships with community providers and community service agencies, ensuring that the integrity of care and service is monitored at those sites
Understands community health challenges and works with director and division staff and colleagues to develop and implement practices, education programs, and other strategies to improve the health of the community and to promote continuous improvement in health status across the continuum
Visits community care providers to develop rapport, understand service offerings, and insure quality and consistency of services
Diligently supports and participates in division and market specific strategies
Works with post acute care staff to develop community strategies for post acute and community services
Care Facilitation and Coordination
Accountable for transitions of care and care across the continuum
Orchestrates care between multiple care delivery sites and multiple caregivers
Performs cross continuum care activities, which may include clinic, physician practice, urgent care, patient home, skilled care, remote monitoring or other sites of care
Synchronizes care with all providers and colleagues
Mobilizes resources to move patients through the hospital stay and across the continuum of care efficiently and effectively
Adheres to MHS Transitions of Care standards
Interacts with consulting physicians and other healthcare providers to facilitate throughput
Collaborates closely with social work colleagues on all aspects of care delivery
Works quickly to address barriers and challenges associated with cross continuum care coordination and engages colleagues and staff in hard wiring appropriate solutions
Accountable for accurate and timely documentation
Monitors documentation in the medical record daily, to ensure that care is accurately reflected
Assists and collaborates in the management of patients with chronic diseases following established protocols and interventions
Ensures absolute compliance with CMS and other regulatory initiatives
Manages and includes in the plan of care, contributing factors such as obesity, age, diabetes, medications, etc.
Coordinates healthcare interventions for populations with significant health conditions in which self-management efforts are critical
Proactively manages payer communications and issues
Assesses the need for, sets up and monitors remote monitoring equipment for patients.
Ensures that appropriate handling of any issues generated through remote monitoring program.

Knowledge
Participates in pertinent, ongoing, relevant education that contributes to professional knowledge and enhances practical abilities. Attends 70% of division educational programs.
Attains significant knowledge of Population Based Care, Clinical Integration and Accountable Care
Provides at least two educational programs per year to hospital staff
Participates in and supports research activities
Develops expertise on Centers for Medicare and Medicaid (CMS) rules, regulations, payment changes and trends, demonstration projects, and required data submissions
Stays abreast of CMS core measures and National Patient Safety Goals (NPSGs)
Stays abreast of industry trends and regulations and serves as resource for staff, colleagues, and physicians
Maintains proficiency in reimbursement and denials management including physician and hospital, inpatient and outpatient payment structures, payer contracts, and health industry changes
Adequate knowledge of normal ranges of vital signs as it pertains to chronic illnesses.
Assessment & Analysis
Accesses and acts on information related to readmissions, throughput activities, denials, and barriers to effective care
Stays alert for, and acts upon opportunities for, improvement of care and processes
Maintains constant awareness of performance and service outcomes, inclusive of financial, operational, process, value, and relational coordination measures
Understands and analyzes data related to patient populations/conditions and develops a plan of action. Monitors progress over time and initiates changes as needed
Immediately addresses deficits as they are identified, including those that arise through remote monitoring.
Engages physicians, hospital staff and leaders, and community partners in analysis, intervention and resolution activities for all departmental programs.
Works with colleagues to eliminate avoidable days and denials
Collaborates with colleagues to quickly address all potential financial losses identified through denial management processes
Leads clinical cost reduction opportunities
Executes cost reduction/containment strategies without adversely impacting patient care within the organization
Identifies, studies and acts upon at least two significant clinical cost reduction activities per year in collaboration with physicians and possibly other clinical partners and reports work process barriers
Collaborates with physicians and colleagues to develop a plan of action to promote appropriate utilization of resources across the continuum
Anticipates and troubleshoots claim and reimbursement issues
Provides feedback that will enhance payer negotiations
MHS Other
Contributes to the success of the organization by meeting organizational competency expectations and core values (respect, integrity, stewardship, excellence, collaboration and kindness), continuously learning, and by performing other duties as needed or assigned
Adheres to MHS Attendance and Punctuality Policy and Procedure standards. Maintains reliable attendance

VALUES BASED BEHAVIORS

Respect: Seek first to understand
Integrity: Do the right thing
Stewardship: Live lean
Excellence: Be your best/Act for safetys sake
Collaboration: Team up
Kindness: Create warmth and comfort

MIMIMUM QUALIFICATIONS
KNOWLEDGE, SKILLS, & ABILITIES
Information and Decision Making
Demonstrates critical thinking skills, ability to assess, problem solve, and effectively make decisions
Learns quickly and is able to mine useful information and data from multiple sources
Comfortable taking measured risks
Ability to accurately interpret data, critically analyze data and challenge data as appropriate
Can quickly focus in on the mission-critical agenda
Interpersonal Skills
Leads people well through teaching, role modeling, challenging, supporting and communicating
Communicates and works effectively in highly matrixed settings
Warm, friendly and interpersonally agile, easy to approach and talk with
Behaves consistently with a core set of values, beliefs
Strong conflict management and negotiation skills
Creative and visionary approach to problem solving
Effective Use of Self
Excellent time management skills
Ability to thrive in a high pressure environment
Acts with integrity in adversity
Self insight, self development
Personal Resources
Enthusiastic and high energy, drive and ambition
Understanding of the healthcare industry and business
Understanding of the payer industry and business
Writes and presents effectively, and adjusts content for the audience
Addresses challenges head on and quickly, through resolution

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