Nurse Care Manager - Remote (New York)
Care Centrix New York, NY
Post Acute is an end-to-end post-acute offering that manages up to 90-day episodes of care, beginning prior to the patient’s discharge from the hospital, or for elective surgical cases, outreach begins prior to hospitalization. The program optimizes our home-based network, identifies the likely best site-of-care for the patient, manages length of stay (LOS) if a Skilled Nursing Facility (SNF) is appropriate, and reduces hospital readmissions. Our program also coordinates all of the services required for a patient to transition to their home faster and safer, via our network of home health, durable medical equipment and home infusion providers, all of whom are supported by our CareCentrix care coordination team.
The Nurse Care Manager is an in-market position and is responsible for an assigned caseload at assigned acute and post-acute care facilities. The Nurse Care Manager will conduct in person, on site initial face to face outreach with patients to introduce the Post Acute program, gather patient demographics and collaborate with hospital clinicians, patient and family to develop a discharge path of care. The Nurse Care Manager will coordinate PAC services for the patient and collaborate with Post Acute homecare agencies on PAC plan of care, authorizing services as medically necessary. The Nurse Care Manager will document patient interactions and plan of care in the Homebridge care coordination platform.
- Manages the transition of assigned Post Acute patients from acute care setting to the skilled nursing facility and/or home setting utilizing face to face and telephonic outreach to accomplish the goals of the Post Acute Program. Care coordination and facilitation with hospital discharge planners, case managers and hospitalist to obtain Post Acute orders for engagement.
- Authorize admission and continued stay at Skilled Nursing Facilities and Home Health care using approved medical care guidelines and collaboration with physicians and professionals within the healthcare setting.
- Engages and coaches the patient/caregiver assigned using telephonic outreach and standard assessments, patient care plans, and document progress in Homebridge care coordination platform. Documents all interactions, problems, goals and interventions as well as criteria met ensuring documentation guidelines are maintained.
- The Nurse Care Manager will also communicate patient plan of care and discharge status with the Primary Care Physician and/or Specialist.
- Works closely with the Post Acute patient home health agency nurse to facilitate education and adherence to establish health care goals and care plan.
- Facilitates obtaining appropriate home health physician orders for the home care services.
- Acts as a clinical resource for unlicensed Post Acute Care Coordinators, providing clinical expertise and helping to clarify referral source directives. Receives/responds to requests from unlicensed staff regarding scripted clinical questions and issues.
- Identifies patients who meet criteria for other Health Plan programs upon patient graduation from the Post Acute program and communicating patient information to the Health Plan contact(s).
- Participates in performance and operational improvement activities. Contacts referral sources to advise them of referral status. Relays referral status and updates to the assigned health plan case managers.
- Communicates customer service/provider issues to supervisor for logging and resolution.
- Participates in and contributes to ongoing quality assessment/improvement activities, ensures the collection of data for improvement analysis and prepares reports as requested.
- Assists team in implementing and maintaining standardized operational processes to ensure compliance to company policies, legal requirements and regulatory mandates.
- Participates in implementing / maintaining operational processes to ensure compliance to company policies, legal requirements and regulatory mandates.
- Participates in special projects and performs other duties as assigned.
- Must be willing to travel 75% of the time within assigned geography and occasionally to central CareCentrix locations.
- Current and unrestricted license for the market (state) of practice as a Registered Nurse. Minimum five years of nursing experience, preferably with a geriatric population.
- Expertise in Utilization Management and knowledge of URAC standards. Broad knowledge of health care delivery/managed care regulations, contract terms/stipulations, prior utilization management/case management experience, and governmental home health agency regulations required.
- Excellent negotiation, communication, problem solving and decision making skills also required.
- Ability to travel frequently to hospitals, skilled nursing facilities, and physician practices within the geographic location assigned.
- Candidate will possess excellent communication (verbal/written), organizational and interpersonal skills.
- This position requires high level clinical knowledge, communication, customer service and problem solving skills, as well as, the ability to effectively interact with all levels of management and a highly diverse clientele. Must have strong organizational skills and be able to effectively manage and prioritize tasks.
- Works independently, utilizing sound clinical judgment and critical thinking skills under minimal supervision.
- Must have a strong commitment to quality and standards.
CareCentrix maintains a drug-free workplace in accordance with Florida’s Drug Free Workplace Law.