Northern Light Health
Department: Care Management
Position is located: 797 Wilson Street
Work Type: Full Time
FTE: 1.000000: (40 hours per week)
Work Schedule: 7:30 AM to 6:00 PM
Provides leadership in the coordination of patient-centered care across the continuum, develops a safe discharge plan through collaboration with patients / caregivers and multidisciplinary healthcare team. Facilitates episode orf care to maximize appropriate level and LOS, patient experience and and quality of care., and level of care., and reimbursement for all patients
- Provides leadership in the coordination of patient-centered care across the continuum, develops a safe discharge plan through collaboration with the patients / caregivers, and multidisciplinary healthcare team and post-acute providers to arrange support an appropriate, cost effective post- acute discharge plan services and optimal transitions in care in conjunction with available resources
- Drives to appropriate DRG length of stay, level of care and patient experience, . and reimbursement level of care for all patients
- Promotes patient advocacy in an independent care model
- Develops an optimal, l patient individualized, transition plan for patients with goal to reduce readmission and to support continued plan of care; regardless of next level of care
- Maintains a working knowledge of current care management practices and philosophy; including changes within, care coordination changes, utilization review changes, authorization changes, contracts changes, regulatory requirements, etc.; and serves as an educational resource to all Health System staff regarding utilization review and discharge planning
- Screens patients for admission, and concurrent medical necessity, and post-acute care needs
- Assessment of physical, psychosocial, & economic needs for transition of care planning to a variety of levels of care; delegates to others as appropriate. Assesses patients who have been identified as needing post needing post-acute transition or care management needs.
- Refers to other care team members to meet holistic needs of patient, i.e. social work, nutrition, physical therapy, spiritual care, financial counselors and others.
- Documents, verifies, and validates specific data required to monitor and evaluate interventions and outcomes
- Interviews and collects patient specified data and chart review related to readmission and appropriately notifies care team
- Collects patient specific data to assist in quality and improvement of patient care
- Communicates telephonically and electronically with outpatient providers in an effort to enhance the continuum of care
- Integrates performance improvement principles and customer service excellence principles into all aspects of job responsibilities; practice and governmental commercial payer guidelines
- Adheres to the policies, procedures, rules, regulations, and laws of the hospital and all federal and state regulatory bodies
- Assumes responsibility for NL EMMC Health required continued education and owns professional growth
- Performs other duties as assigned or required
BLS Required. ACM, CCM or other certification applicable to utilization management approved by manager within 3 years of hire as approved by manager.
Competencies and skills:
* 3+ years of relative work experience required.
* Achieves Results: Sets high standards for their own outcomes and seizes opportunities to engage others towards objectives. Consistently moves forward with direct actions in order to attain or exceed objectives. Manages their own time effectively to accomplish assigned tasks. Successfully prioritizes multiple projects and duties as needed.
* Acts Strategic: Creates effective plans that anticipate future consequences and opportunities and is able to connect the day to day operations to longer-term objectives, shifts in the industry, and system goals.
* Applies Business Acumen: Demonstrates knowledge of current and future trends that impact organizational success. Applies proven practices and business theories to get results that meet financial as well as other business goals. Recognizes opportunities for new services and products and acts accordingly, taking measured risks into consideration. Possesses a thorough knowledge of their field and independently carries out their work in accordance with professional standards of the profession.
* Behaves with Integrity and Builds Trust: Acts consistently in line with the core values, commitments and rules of conduct. Leads by example and tells the truth. Does what they say they will, when and how they say they will, or communicates an alternate plan.
* Cultivates Respect: Treats others fairly, embraces and values differences, and contributes to a culture of diversity, inclusion, empowerment and cooperation.
* Demonstrates Adaptability: Learns quickly when facing a new problem or unfamiliar task; is flexible in their approach with changing priorities and ambiguity. Manages change effectively and does not give up during adversity. Capable of changing one's behavioral style and/or views in order to attain a goal. Absorbs new information readily and puts it into practice effectively.
* Demonstrates Emotional Intelligence: Exhibits a high level of self-awareness, self-management, other awareness and relationship management. Conducts themselves in an empathic, appropriate way, with a sense of humor and stimulates a collaborative work environment. Is respectful of the attitudes, feelings, or circumstances of others and aware of the influence of their own behavior on them. Is aware of relevant social, political, system, and professional trends and developments and uses this information for the organization's benefit.
* Effectively Communicates: Listens, speaks and writes appropriately, using clear language. Communication methods are fitting to the message(s), audience, and situation and follow-ups are regular and timely. Shows that important (non-) verbal information is absorbed and understood and asks further questions to clarify when necessary. Expresses ideas and views clearly to others and has ability to adjust use of language to the audiences' level.
* Exercises Sound Judgment & Decision Making: Understands and processes complex information, which allows for appropriate and accountable conclusions. Does not react too quickly or slowly. Balances facts, goals, and potential approaches taking the appropriate criteria into account. Makes active decisions and commits oneself by communicating confidently and respectfully.
* Fosters Accountability: Creates and participates in a work environment where people hold themselves and others accountable for processes, results and behaviors. Takes appropriate ownership not only of successes but also mistakes and works to correct them in a timely manner. Demonstrates understanding that we all work as a team and the quality and timeliness of work impacts everyone involved.
* Influences and Inspires: Builds enthusiasm and commitment among others to move in a desired direction and models it personally. Creates a compelling vision of success that motivates workplace initiative and energizes others to follow. Provides direction and guidance to encourage cooperation between team members in order to attain an objective. Has the ability to appropriately influence others' actions and decisions with and without express authority.
* Practices Compassion: Exhibits genuine care for people and is available and ready to help; displays a deep awareness of and strong willingness to relieve the suffering of others.
* Provides Patient-Centered Care: Demonstrates understanding of patient care quality and service as organizational priority. Proactively supports change to improve patient experience and results. Exhibits the ability and willingness to find out what the patient wants and needs and to act accordingly, taking the organizational and outside resources into account. Cooperates, collaborates, communicates, and integrates care within and between teams to ensure that care is continuous and reliable.
* Registered Nurse
* Associate's Degree
* Potential exposure to abusive and/or aggressive people.
* Work with computers, typing, reading or writing.
* Potential exposure to diseases or infections.
* Need to drive to perform responsible duties.
* Potential exposure to hazardous materials.
* Lifting, moving and loading 20 to 30 pounds.
* Potential exposure to noise levels being uncomfortable.
* Continuous sitting.
* Potential exposure to noxious odors.
* Continuous standing.
* Potential exposure to very hot or cold temperatures.
* Continuous walking.
Equal Opportunity Employment
We are an equal opportunity, affirmative action employer and all qualified applicants will receive consideration for employment without regard to race, color, religion, age, disability status, gender, sexual orientation, ancestry, protected veteran status, national origin, genetic information or any other legally protected status