Care Manager - Palliative Medicine & Support Care

Position Overview

Full‑time position. First Shift (Days – less than 12 hours per shift). 40 hours per week. Not exempt.

The Care Manager (Palliative Medicine) serves in an expanded nursing role to collaborate with patients and their health care team including the Palliative Medicine team, Primary Care Providers, specialists, and hospital staff and physicians to provide a model of care that ensures the delivery of quality, efficient and cost‑effective Palliative Medicine services across the continuum. The Care Manager (Palliative Medicine) functions as a coordinator of patient care, assesses, plans, implements, monitors, and evaluates all options and services with the goal of optimizing the patient’s quality of life.

The Care Manager (Palliative Medicine) integrates evidence‑based clinical guidelines, preventative guidelines, protocols, and other metrics in the development of transitions of care plans that are patient‑centric, promoting quality and efficiency in the delivery of healthcare for the targeted high‑risk population. The Care Manager (Palliative Medicine) monitors patients across the health continuum with a focus on effective and safe transitions through the healthcare system with a goal to optimize resources, quality of life, and reduce avoidable readmissions back to acute care.

The Care Manager (Palliative Medicine) manages performance feedback metrics to further refine the care model to maximize clinical, quality, and fiscal outcomes for the targeted population. This role will also complete tasks related to patient assessments, rounding with the PM&SC providers, providing support for organizing and completing tasks with PM&SC providers, providing support of discharge processes and patient charges. The delivery of professional nursing care at Stormont Vail Health is guided by Jean Watson’s Theory of Human Caring and the theory of Shared governance, both of which are congruent with the mission, vision, and values of the organization.

• Bachelor’s Degree
• Bachelor of Science in Nursing (BSN)
• 2 years nursing experience in an acute or ambulatory setting. (Preferred)
• Required experience with palliative care.
• Preferred case/care management experience.

• Demonstrates prudent professional and clinical judgement, effective problem‑solving skills, critical thinking, excellent organizational and interpersonal skills, creativity, flexibility, and the ability to multi‑task. (Required proficiency)
• Demonstrates ability to be self‑directed and purposeful in seeking the necessary knowledge and skills to enhance professionalism in order to provide high‑quality care. (Required proficiency)
• Demonstrates ability to function effectively in a fluid, dynamic, and rapidly changing environment. (Required proficiency)
• Demonstrates customer‑focused interpersonal skills to interact in an effective manner with practitioners, the interdisciplinary health care team, community agencies, patients, and families with diverse opinions, values, and cultural ideals. (Required proficiency)
• Demonstrates ability to work autonomously and be directly accountable for practice. (Required proficiency)
• Demonstrates leadership qualities including time management, verbal and written communication skills, listening skills, priority setting, and work organization. (Required proficiency)

• Registered Nurse – KSBN
• Basic Life Support – BLS (required within 90 days of hire)

• Actively participates with Palliative Medicine team meetings and participates in the expansion of Palliative Medicine services.
• Collaborates with the Palliative Medicine team and Palliative Medicine physicians, social work staff, and other care team members to ensure optimal care coordination for the patient.
• Establishes and maintains a supportive, collegial role with primary care/specialty practices engaged in improvement activity, particularly including assigned practices and their individual improvement team members.
• Initiates communication with patients upon learning they have been identified as high risk / targeted population.
• Pulls data from multiple systems and merges them to create a…