Johnson City, Tennessee
Case Manager Job Opening in Johnson City, Tennessee - SUMMARY: Under the supervision of the Health Informatics Program Coordinator, the Case Manager is responsible for managing a caseload taken from a population of individuals that meet requirements for various quality programs. The Case Manager works closely with clinical support staff, nursing leadership, physicians, the quality department, and the information technology department to achieve system goals of improving clinical outcomes for patients with chronic diseases; assists with the development of processes that support the quality programs, ensures all CMS regulations have been met in order to bill and receive reimbursements that support the program for continued growth; and performs other related duties as assigned.
ESSENTIAL DUTIES AND RESPONSIBILITIES include the following. Other duties may be assigned.
Manages a caseload of an assigned panel of chronic care patients.
Collaborates with physicians, providers, and practice staff in identifying appropriate patients for care management.
Develops relationships with patients as an integral member of the team.
Provides follow-up management with patients to ensure compliance with their individual care plan.
Maintains availability to provide telephone advice per protocol, and handles urgent and emergency calls.
Anticipates the needs of the patient population, seeing that necessary documentation and pre-visit planning is completed or requested before patient visit.
Promotes patient self-management and empowers patients/families to achieve maximum levels of wellness and independence.
Determines and coordinates appropriate referrals as needed.
Works with patients and patient?s care team to coordinate change readiness, needs assessment and to develop an individualized treatment care plan.
Collaborates with the patient, physician, and other care team members in assessing the patient?s progress toward individual health care goals.
Maintains accessible, consistent documentation of patient self-management measures, and reporting progress toward goals.
Assists patients in setting achievable goals for self-management, teaches them how to do self-management tasks, and reports abnormal findings to their care team.
Assesses barriers when the patient has not met treatments goals, is not following the treatment plan of care, or has not kept important appointments.
Oversees the development, procurement, and adoption of patient self-management educational resources used by the primary clinical teams.
Utilizes the Institute for Healthcare Improvement (IHIs) Chronic Care Model as the foundation and framework for chronic illness care management.
Participates in regular team meetings and peer review activities.
Promotes collaborative teamwork and is able to work with peers in a team situation.
Collaborates with other Case Managers for additional services when appropriate.
Develops a list of medical supply and community resources available to patients and maintains collegial relationships with the entities used most frequently.
Makes recommendations for policies/procedures to ensure that preventive services are offered in a timely manner to all who qualify.
Provides follow-up in the transitions of care from various settings (hospital or skilled nursing facility discharges and emergency room visits).
Coordinates disease registry activities.
Interfaces with insurance companies? patient data systems and coordinates efforts to achieve goals for patient care; compiles and abstracts data for multiple clinical measures (PCMH, MIPS, CPC+, etc.).
Gathers and manages data for research projects and participates in research programs as needed.
May conduct home visits in order to assess safety, medication compliance, and the patient?s home environment.
Participates in departmental and organizational committees as applicable.
KNOWLEDGE, EDUCATION AND/OR EXPERIENCE: The Case Manager must have knowledge of the Patient-Centered Medical Home model/mission as well as knowledge of insurance industry practices and requirement. He/she must have an understanding of chronic disease and preventive care measures. Must have a bachelor?s degree in health care administration, health informatics, or a related field and hold licensure as a Licensed Practical Nurse, or an incumbent holding licensure as a Licensed Practical Nurse and having significant experience in chronic care may be considered. Licensure as a Registered Nurse is preferred.
EOE / AA ? M/F/Disability/Vet
Quillen ETSU Physicians participates in E-verify
Candidates are encouraged to visit /resources to submit a complete application
Job Type: Full-time
Required education:
Bachelor's
Required license or certification:
LPN/RN
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