Description

 JOB SUMMARY

The Care Manager is responsible for care management and resource management for an assigned registry of patients through collaboration with patients, their caregivers and providers. They will work to identify patients' medical, behavioral, and social needs and identify barriers to care. The Care Manager monitors both concurrent reviews to ensure that the patient is getting the right care in a timely and cost-effective way and retrospective reviews after treatment has been completed. The Care Manager ensures that available resources are being used in a timely and cost-effective manner in order to obtain value for patient, payer and provider.

DUTIES AND RESPONSIBILITIES

A. Provides care management to high-risk and rising-risk health plan patients.

B. Manages assigned patient registry to improve risk score and utilization of resources. 

C. Develops and advances care plans and timely completion of goals.   

D. Promotes quality and improves patient care by enhancing education and communication between the patient and the care team, developing and advancing care plans, care monitoring and care transitions, and routine assessment of barriers to care. 

E. Provides education to patient, family and caregivers on health conditions, medications, prevention of adverse outcomes, available resources and appropriate utilization and access to resources.

F. Ensures all involved are up to date on the latest tests results and information. 

G. Proactively identifies problems and promptly initiates appropriate actions. 

H. Keeps up-to-date and detailed records on all patients.

I. Participates in the agency’s CPI Program.

J. Performs other duties as required. 

Requirements

A. Education: Graduation from an accredited school of Nursing. Minimum of LVN License; Must maintain current licensure with the Texas Board of Nurse Examiners. 

B. Other: Strong written and oral communications skills, attention to detail, and flexibility. Bilingual/Bicultural (preferred); Capable of working well in a diverse team environment; ability to maintain a professional attitude and demeanor at all times including high pressure situations; must demonstrate problem solving skills. 

A. Must be able to perform the essential functions of the position.

B. Must be able to meet the attendance requirements of the position.

C. Must not pose a direct threat to the health or safety of other individuals in the workplace.