Quality​/RN Case Manager

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.

• 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

• 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.

• 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…