The Care Manager RN 1 QA will be responsible for assessing and coordinating patient care across the continuum, utilizing accepted criteria and guidelines to manage benefits and determine medical necessity of services provided. This position will function as a clinician, case manager, and educator to achieve optimal clinical and quality outcomes by effectively managing care and resources to reduce unnecessary utilization.
ESSENTIAL FUNCTIONS OF THE ROLE
Assesses plans, implements, documents, coordinates, monitors, evaluates and updates the plan of care by collaborating with all members of the health care team to provide evidenced based care.
Establishes patient care management plans, interventions, treatment goals and self-management goals.
Assesses the health care, educational and psychosocial needs of the patient and family.
Assists patients with self-management through education, visits and telephonic engagement; encourages and supports patient adherence to their care plans.
Researches, evaluates and recommends resources to meet medical and non-medical needs of patients and families. Collaborates, refers and communicates across all programs to ensure appropriate coordination of services.
Researches and takes an active role in identifying problems and possible solutions in the coordination of care to determine most appropriate setting.
Acts as liaison to hospitals, primary care providers, post-acute partners and specialists.
KEY SUCCESS FACTORS
Specialty Certification strongly encouraged.
Knowledge of care management, resource and utilization management.
Skilled in care management and patient assessments.
Excellent verbal and written communication skills required.
Ability to monitor, assess and record patient progress against a plan of care.
Ability to facilitate patient access to community resources.
Ability to work collaboratively with both internal and external medical staff and external partners and organizations.
Ability to assess, adapt, and calmly respond to changing and crisis environment.
Ability to maintain confidentiality with all aspects of patient information in accordance with all applicable policies and regulations.
Our competitive benefits package includes the following - Immediate eligibility for health and welfare benefits - 401(k) savings plan with dollar-for-dollar match up to 5% - Tuition Reimbursement - PTO accrual beginning Day 1 Note: Benefits may vary based upon position type and/or level
Baylor Scott & White Health (BSWH) is the largest not-for-profit health care system in Texas and one of the largest in the United States. With a commitment to and a track record of innovation, collaboration, integrity and compassion for the patient, BSWH stands to be one of the nation’s exemplary health care organizations. Our mission is to serve all people by providing personalized health and wellness through exemplary care, education and research as a Christian ministry of healing. Joining our team is not just accepting a job, it’s accepting a calling!