The Care Manager facilitates transition of care planning with an interdisciplinary healthcare team to achieve quality outcomes, reduce costs and ensure patient safety.
We’re a Little Different
Our mission is clear. We bring to life a healing ministry through our compassionate care and exceptional service.
At Mercy, you’ll feel our supportive community every step of your day, especially the tough ones. We’re a team and love working that way. We have opportunities for nurses who are inspired to pioneer new models of care and want to transform the healthcare experience. Work with advanced technology and innovative procedures. Be state of the art, and never stop exploring. We’re expanding to help our communities grow, offering an exceptional opportunity to join our team.
Actively supports Care Management plans and processes to measure, assess and improve quality, resource management, patient outcomes and Care Management metrics.
- Reports to Care Management leadership, the identification of avoidable days and other Care Management measures including, but not limited, readmissions, saved days, core measure monitoring, interventions, and delays, to ensure data is accurately collected.
- Implements strategies in collaboration with the healthcare team to reduce length of stay (LOS) and resource utilization, never compromising quality or outcomes.
- Ensures patients are in the appropriate LOC according to evidenced based, physician approved criteria and standards and prescribed plan of care
- Ensures authorizations for post acute services are obtained in a timely manner
- Facilitates denial management of post acute services
Facilitates the discharge planning process to ensure patient throughput by (add) collaborating with the healthcare team.
- Prioritizes patient’s need for Care Management services based on: target/high volume Diagnosis-Related Group (DRG), high cost, outlier, LOS, frequent inpatient admissions, unplanned readmission or significant variance.
- Identifies risk factors for potential crisis intervention needs related to clinical diagnosis, prognosis and/or patient/family dynamics.
- Identifies and reports ethical situations to manager/supervisor and Ethics Committee for resolution.
- Ensures the multidisciplinary discharge plan is consistent with the patient’s clinical course, continuing care needs and covered services. Evaluates on an ongoing basis the patient’s status and progress toward reaching goals set forth in the plan of care.
- Supports the patient/family decision regarding advance directives or verifying a surrogate decision maker.
- Works collaboratively to assess for clinical, spiritual, financial, educational, functional and psychosocial baselines for patient/family to determine appropriate and realistic outcomes.
- Educates patient/family/support system on the plan of care and expected outcomes. Improves patient/family understanding of and adjustment to the medical diagnosis/prognosis or other care issues.
Emergency Department (ED) Care Management
- Identifies target patient populations most likely to have discharge needs such as but not limited to Primary Care Physician (PCP) Identifies Level of Care (LOC) needs and facilitate discharge planning elderly, chronically ill, underserved, limited or ineffective support system, polypharmacy issues, no Primary Care Physician (PCP) Identifies Level of Care (LOC) needs and facilitate discharge planning of appropriate patients treated ED; thereby reducing ED re-visits or subsequent admissions.
Identifies the appropriate LOC (Inpatient, Outpatient Observation Stay) and collaborates with the attending Physician as indicated.
Identifies and provides community resources to ensure a safe transision of care.
Communicates effectively and provides education.
Collaborates with patients, families and other members of the healthcare team to facilitate care coordination.
Handles complaints/concerns in a prompt and courteous manner; assesses and directs to appropriate person to deal with concerns as needed.
- Care Manager provides patient and family education as it relates to discharge plan.
Portrays a positive professional public image at all times.
- Consistently works toward standards of excellence to continually improve personal performance.
- Develops professional relationships with community partners.
Builds and maintains positive, professional relationships with the healthcare team, placing organizational/team goals first.
Assumes responsibility, authority and accountability for assigned work, seeks to assist team members and identifies opportunities for process improvements.
Documents data accurately in the electronic medical record and applicable programs to ensure data for tracking and trending is accurate.
Maintains technical knowledge and skills of computer and integrated software systems.
Maintains current knowledge of online verification/ precertification process with insurance carriers.
Other: Performs other duties as assigned
- Graduate of an accredited School of Nursing, Minimum Required
- Bachelors Degree of Science in Nursing, Required for Care Manager
- Current License in the state of employment, Minimum Required
- 2-3 years acute care hospital setting, Minimum Required
- Care Management or Utilization Management experience, Preferred
- BLS (CPR) at hire date, Minimum Required, or within 90 days of hire
- Certification in Case Management, Preferred
Other Skills & Knowledge
- Strong verbal and written communication and facilitation skills, Minimum Required
- Strong assessment skills, time management skills, critical thinking skills, Minimum Required
- Advanced computer skills, Minimum Required
- Must have ability to interact effectively with a variety of people and situations at all levels of the organization, Minimum Required
- Knowledge of InterQual criteria, Preferred
We’ll Support You at Work and Home
Getting respect doesn’t come easy in healthcare. Modern Healthcare Magazine named us as a “top 100 places to work.” We go out of our way to help people feel welcomed. We offer day-one comprehensive health, vision and dental coverage, PTO, and employer-matched retirement funds, even to part-time employees. We’re proud to provide tuition reimbursement to help you grow and learn new skills.
What Makes a Good Match for Mercy
Compassion and professionalism go hand-in-hand with us. Having a positive outlook and a strong sense of advocacy is in perfect step with our mission and vision. We’re also collaborative and are not afraid to do a little extra to deliver excellent care-that’s just part of our commitment. If that sounds like a fit for you as well, we encourage you to apply.