Care Management Consultant

GENESIS HEALTHCARE SYSTEM
In order to fill our Mission of serving our community by helping each person achieve optimal health and well-being by providing compassionate, exceptional, and affordable healthcare services, all employees of Genesis HealthCare System must be committed to living the Genesis Mission and Genesis values of Compassion, Excellence, Integrity, Team, and Innovation. All employees must regard themselves as an ‘owner’ of Genesis and keep our patients at the center of everything we do - always.
Position Details:
Work Shift:
Varied Shift (United States of America)
Scheduled Weekly Hours:
0
Department:
Cardiovascular Surgery
Overview of Position:
Performs a wide range of performance improvement duties.; Coordinates the implementation of quality initiatives at Genesis Physician Services. Works with data collection and analysis to improve care in ambulatory practices. Conducts quality and safety assessments and develops action plans and follow up on areas of concern. Interacts with physicians and helps guide them on process/outcome improvements. Collaborates with practice managers and staff to improve clinical processes and quality of care. Coordinates skills evaluations and clinical competencies for practice staff.JOB SUMMARY
The Care Management Consultant functions to ultimately assist patients through the healthcare system by acting as a patient advocate and navigator.
The Care Management Consultant creates longitudinal personalized care plans for patients, collaborates with and coordinates the efforts of providers across the continuum and increasingly uses data analytics to manage the health of populations.
ESSENTIAL DUTIES
1. Transitional and longitudinal care planning and execution
Conducts assessments of patient/family needs by coordinating input from all health professionals and formulating a documented plan assuring continuity of care for the highest risk patients
Coordinates continuity of patient care with patients and families following hospital admission, discharge and ER visits
Delegates care based on situation while assuming accountability for patient outcome. Supports assistive personnel; serves as a resource and holds assistive personnel accountable to complete delegated tasks
Along with physician hospitalists/PCPs/APPs/specialists, leads and coordinates activities of interdisciplinary treatment team required to make high risk clinical, benefit and network decisions
2. Communication and coordination between care settings
Identifies appropriate providers, facilities, external healthcare organizations throughout the continuum of care and communicates with an interdisciplinary treatment team to develop and maintain positive working relationships with patients, families and providers
Functions as a coordinator and manager of a defined health population across multiple care settings and for multiple physicians/health care providers or health plan counterparts
Coordinates care across the continuum (inpatient/outpatient/community) to assure appropriate utilization of clinical and community resources
Works collaboratively with primary care practices to offer individualized assistance with improving and maintaining quality patient care
Guides development of multiple health care partnerships to achieve a positive health effect
Ensures that transitions of care are completed for his/her assigned patients, and that patient has the appropriate resources to improve care outcomes and prevent readmissions. Explains system wide care management to their patients and ensures that they know how to reach them when they have questions or concerns. Considers the patient’s goals and preferences when developing the patient’s system wide care plan.
3. Utilization management and data analytics
Manages high risk patient care, including management of patients with multiple co-morbidities or high risk for readmission to a hospital setting, using a patient registry when appropriate
Participates in data collection, health outcomes reporting, clinical audits and programmatic evaluation as needed
Analyzes data to identify under/over utilization; improve resources consumption; promotes potential reduction in cost; and enhances quality of care consistent with organization strategic goals and objectives. Data includes but is not limited to predictive analysis, risk stratification, cost-benefit analyses, financial analyses; clinical outcomes; utilization and practice patterns
Assist with on-going review / readmission root cause analysis and action plan development associated with your assigned population of patients.
4. Skills Required
Excellent communication skills (oral and written)
Excellent customer service skills
Proven leadership skills
Ability to work independently, setting priorities to coordinate care plan efficiently
Ability to work effectively in a team environment
Highly organized and detail-oriented
Ability to perform multiple tasks
Effective behavioral and educational strategies, including but not limited to motivational interviewing, teach-back method and self-management support
Confidence to communicate and outreach to other community health care organizations and personnel
Ability to use sound judgement, decision-making and problem-solving
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undefined QUALIFICATIONS-LEVEL11. Current Ohio RN licensure, Licensed Social Worker (LSW) or Counselor (LPC) in the State of Ohio. Licensure.a. If RN, must also have ADN with 3 years of clinical RN experience.b. If LSW or LPC, Bachelor’s degree in Social Work.2. Strong analytical, data management and computer skills.3. Current working knowledge of discharge planning, utilization management, case management, performance improvement and managed care reimbursement. QUALIFICATIONS-LEVEL 21. Current Ohio RN licensure. Must also have ADN with 3 years of clinical RN experience.2. Three years clinical experience and 2+ years of CM/UR/Navigator/Coordinator/leadership experience or Case Management Certification or approved alternate certification that is applicable to the assigned service area.· Has effectively demonstrated Leader skills associated with performance as department team leader, mentor, motivator, positively influences patients and others. In addition, has demonstrated department project management skills. · Current working knowledge of discharge planning, utilization management, case management, performance improvement and managed care reimbursement.· Understanding of pre-acute and post-acute venues of care and post-acute community resources. QUALIFICATIONS-Level 31. Current Ohio RN licensure. Must also have ADN with 3 years of clinical RN experience.2. Three years RN clinical experience and 5+ years of CM/UR/Navigator/Coordinator/leadership experience or Case Management Certification or approved alternate certification that is applicable to the assigned service area.· Has effectively demonstrated Leader skills associated with performance as department team leader, mentor, motivator, positively influences patients and others. Has demonstrated department project management skills.· Current working knowledge of discharge planning, utilization management, case management, performance improvement and managed care reimbursement.· Understanding of pre-acute and post-acute venues of care and post-acute community resources.· Experience with creating and managing KPIs and/or other goal setting and monitoring techniques.· Experience developing or leading projects. CARE MANAGEMENT LEVEL GRIDCare Management Consultant Level ICare Management Consultant Level IICare Management Consultant Level IIIParticipates in committee activityMember committee regularlyMember of committeesProvides input on Performance Improvement initiatives for the SWCM teamInput on Performance Improvement initiativesLeads Performance Improvement initiatives Provides Case Study information to the SWCM Team or other committees regarding care managementParticipation in case audits or studies related to care system improvements such as readmission reduction or Multi-Visit Patient (High Utilizer) visit reduction. Participates in project workLeads project work Provides mentorship, training, and other leadership to the team PATIENT CENTERED CARE & BEHAVIORAL EXPECTATIONSLiving the Genesis Mission, Vision and Values• Performs work in a manner that is quality focused.• Treats patients, co-workers, visitors and volunteers with courtesy, compassion, empathy and respect.• R

Skills
Data Analysis, Project Management, Patient Care