Emory Healthcare Decatur , IL 62523
JOB DESCRIPTION: The Emory Coordinated Care case management team is responsible assessing, coordinating, and monitoring the holistic care of assigned populations of Medicare Advantage patients working within a larger interdisciplinary team of physicians, NPs, and MAs.
The goal of the case manager is to utilize available resources to provide quality, cost effective care using selective benefits and alternative services best suited for the member while ensuring optimal outcomes. Additionally the team is sub-delegated to perform health plan case management functions including utilization management (both inpatient and outpatient), disease management, complex case management, and transitions case management. The Manager of ECC Case Management must have expertise in all of these functions, being able to perform each directly themselves while also overseeing and coaching a team to perform them, via audits, feedback, and metric-driven results.
The position requires critical thinking and a self-starter mentality to: assess the needs of the population and CM team members, design de novo process and procedures to address needs, and implement them with operational excellence. The individual must become facile with a number of unique IT platforms for performing job duties and also querying patient data to understand population needs and assess interventions. Metrics for accountability include high-cost utilization (particular inpatient admission rates and SNF bed days), patient engagement, population-wide clinical outcomes (e.g. diabetic control), 360 staff feedback, quality metrics (HEDIS gaps). Other responsibilities include: recruiting and training outstanding new team members, assigning and directing work, oversight of community social work, leadership and direction of interdisciplinary team meetings to discuss high-risk patients, special projects at the direction of the medical director.
MINIMUM QUALIFICATIONS: Graduate of an accredited school of nursing 24 months of recent nursing experience within the past five years. Currently licensed as a Registered Nurse in the state of Georgia.
BLS, ACLS, and Healthcare Provider certifications required. Five (5+) years as a Case Manager. Strongly preferred: management experience; health plan case management experience; experience with utilization management, disease management, and complex case management.
PHYSICAL REQUIREMENTS (Light): 11-20 lbs, 0-33% of the workday (occasionally); 01-10 lbs 34-66% of the workday (frequently) Negligible 67-100% of the workday (constantly), Lifting 20 lbs max, Carrying of objects up to 10 lbs, Occasional to frequent standing & walking; Occasional to frequent sitting; close eye work (computers, typing, reading, writing); Physical demands may vary depending on assigned work area and work tasks. ENVIRONMENTAL FACTORS: Factors affecting environment conditions may vary depending on the assigned work environmental exposures include, but are not limited to:
Blood-borne pathogen exposure. Bio-hazardous waste; Chemicals/gases/fumes/vapors, Communicable diseases, Electrical shock, Floor Surfaces, Hot/Cold Temperatures, Indoor/Outdoor conditions, Latex, Lighting, Patient care/handling injuries, Radiation, Shift work, Travel may be required. Use of personal protective equipment, including respirators, Environmental conditions may vary depending on assigned work area and work tasks