Quality/RN Case Manager

Summary

The Quality Case Manager is a care team member with unique responsibilities that indirectly touch all aspects of patient care. The Quality Case Manager embraces a team-based approach and is comfortable working as part of the patient care team and/or leading teams. The functions of this position include care coordination, patient and staff education, auditing and monitoring quality initiatives. The primary focus of this role will be patient outcomes. The Quality Case Manager must be an advocate and champion of the Patient Centered Medical Home elements.

Essential Duties and Responsibilities

• Manages the Population Health module of Nextgen
• Maintains patient registries for patient populations identified as high risk
• In collaboration with the provider, care team, and patient/family develop a comprehensive plan of care for identified patients
• Provides ongoing monitoring of progress toward meeting goals developed on plan of care
• Meets with patient and family by phone or in person at regular intervals to assess needs and compliance with plan of care, this may involve occasional home visits
• Uses motivational interviewing when working with patients to develop achievable goals
• Collaborates with Baptist ACO care coordinators and Grace Health Patient Care Assistant to coordinate care of high-risk patients to achieve optimal health outcomes and all recommended preventive care
• Uses teach-back methods with patients and families to assess level of understanding
• Routinely uses universal precautions for health literacy when working with patients and families.
• Demonstrates knowledge of performance improvement by participating in collecting, compiling, and analyzing patient data
• Communicates specific pieces of the plan of care to appropriate care team members

Other Essential Duties and Responsibilities

• Communication: Conveys information accurately and efficiently. Written communication is direct, concise, and easy to understand.
• Decision-making: Gathers necessary information to make good and timely decisions. Uses sound judgment and instincts. Seeks direction from Leadership appropriately.
• Supporting/Assisting: Seeks opportunities to help others be successful in meeting goals. Demonstrates behaviors reflective of our mission when helping others.
• Planning/Priority setting: Organizes tasks with objectives in order of importance, timing, and predicted results. Works within measurable goals and outcomes.
• Problem solving: Works systematically to solve problems. Develops reasonable and timely resolutions.
• Initiative: Takes prompt action to accomplish objectives. Seeks to resolve problems without being asked. Seeks direction from Leadership appropriately.
• GH recognizes that managing patient care is a team effort that involves clinical and non-clinical staff. All employees must embrace a team-based approach to patient care and understand that each role is important to our success.
• Team members must demonstrate excellent team communication and coordination to provide quality patient care.
• Care coordination includes communicating with community organizations, health plans, facilities, and specialists.
• Care team members understand and embrace the concept of population management and proactively address the needs of patients and families served by the practice.
• Must demonstrate skill and knowledge related to effective communication with vulnerable patient populations.
• Must participate in Continuous Quality Improvement activities within the organization to ensure patients receive high quality care.

Key Functions

• Working with Payer relations staff to work care gap reports from Payers. Performs chart reviews and communicates with patient and/or Care team to close gaps and alerts providers when needed.
• Provides a coordinated, strategic approach to detect early and manage effectively the chronically ill patient population.
• Knowledgeable of clinical quality measures and preventive health maintenance recommendations. Educates patients, family members, and other staff members in these areas as needed.
• Assists to establish a plan of care with patients, providers, and payers that identifies and continuously re-evaluates cost efficient, appropriate levels of care.
• Understands and adheres to regulations for FQHCs and Primary Care Centers. Maintains a comprehensive working knowledge of community resources, payer requirements, and network services for target populations.
• Understands population health and works collaboratively with the health care team to promote health and wellness.
• Develops strong knowledge of our electronic medical record and the reporting capabilities.
• Works intimately with IT staff and Patient Care Teams to improve quality outcomes.

General Duties

• Follows all organizational policies and procedures, including administrative, clinical, quality assurance, and personnel policies.
• Maintains satisfactory attendance, including attendance at meetings and completion of assigned tasks.
• Maintains timely documentation of all work assignments.
• Maintains patient confidentiality.
• Routinely keeps the supervisor informed regarding attendance and job assignments.
• Demonstrates flexibility and the ability to multitask.
• Works effectively and efficiently.
• Works cooperatively with providers, administration, and peers.
• Proactively acts as a patient advocate, responding with empathy and respect to resolve patient/family concerns.
• Demonstrates continual learning skills, effects changes in approach to care based on established, evidence-based practice.
• Uses motivational interviewing with patients/families/staff members.
• Provides mentoring/coaching to other staff as needed.
• Other duties as assigned by supervisor.

Qualification Requirements:

To perform this job successfully, an individual must be able to support and advance Grace Health's mission while satisfactorily performing each essential duty. The requirements listed below represent the knowledge, skills, and abilities required for the position. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions of the job.

Skills

• Communication
• Computer/Technology
• Conflict resolution
• Customer service
• Team building
• Time management
• Critical thinking
• Leadership
• Motivational Interviewing
• Health Literacy

Education and/or Experience:

Degree in Nursing or other pertinent healthcare Preferred. Current license if applicable. Experience related to quality management/performance improvement.

Experience/Knowledge applicable to job duties will be considered.

Physical Demands:

The physical demands described herein represent those that must be met by an employee to perform the essential functions of this job successfully. Reasonable accommodations may be made to enable individuals with disabilities to perform essential functions.

While performing the duties of this job, the employee is regularly required to talk or hear. The employee frequently is required to stand, walk, sit, and use hands to finger, handle, or feel objects, tools, or controls. The employee occasionally is required to reach with hands and arms, stoop, kneel, crouch, or crawl, and taste or smell.

The employee must occasionally lift and /or move up to 50 pounds. Specific vision abilities required by this job include close vision, distance vision, color vision, peripheral vision, depth perception, and the ability to adjust focus.

Work Environment

Grace Health is a faith-based, federally qualified health center (FQHC). We provide primary healthcare services to underserved, underinsured, and uninsured individuals throughout southeastern Kentucky. Our mission is "to show the love and share the truth of Jesus Christ to southeastern Kentucky through access to compassionate, high-quality primary healthcare for the whole person."

The work environment characteristics described herein are representative of those an employee encounters while performing the essential functions of this position. Reasonable accommodations may be made to enable qualified individuals with disabilities to perform the essential functions of the position.

The noise level in the work environment is typically moderate.

Grace Health provides equal employment opportunities to all employees and applicants for employment and prohibits discrimination and harassment of any type without regard to race, color, religion, age, sex, national origin, disability status, genetics, protected veteran status, sexual orientation, gender identity or expression, or any other characteristic protected by federal, state or local laws.