Clinical Case Mgr Transformation Program

Description

JOB SUMMARY

The role of the Clinical Case Manager position is to support the Healthcare Transformation Program physicians, leaders, and interdisciplinary team in facilitating patient care, with the underlying objective of enhancing the quality of clinical outcomes and patient satisfaction. Through the Healthcare Transformation Program, Swedish and NorthShore Medical Groups are embedding specialty care (cardiology, sports medicine/orthopedics, dermatology, endocrinology and gastroenterology) into Federally Qualified Health Centers (FQHCs) to increase health access and equity. The role integrates and coordinates care between the FQHC primary care setting, The Transformation Program specialists, providers in the hospital setting and staff in programs that address social determinants of health. The Clinical Case Manager will be responsible for assessment and identification of qualifying The Transformation Program patients for enrollment in case management including obtaining informed verbal consent and takes all steps to obtain written consent as appropriate.

RESPONSIBILITIES

Essential Functions

Is primarily responsible for the day to day administration of case management, complex case management and transition of care activities for the Healthcare Transformation Program. The Clinical Case Manager establishes a collaborative relationship with the FQHC Transformation Program patient family, physician(s), and other collaborating providers to determine medical history and current status and to assess the options for optimal outcomes.

• Assesses Transformation Program patient health status and treatment plan and identifies any gaps or barriers to healthcare. Establishes a documented patient centric case management plan involving all appropriate parties (patient, physician, collaborating providers, family, etc.), identifies anticipated case results/outcomes, criteria for case closure, and promotes communication within all parties involved.

1. Provides telephonic support as dictated by patient needs.

2. Provides health education and coaches the patient with treatment alternatives to assist them in making informed decisions about healthcare choices.

3. Assists with coordinating referrals, pre-authorizations and other health care needs.

4. Assists insured and non-insured patients in sorting through their benefits, making choices, and exploring options

• Implements, coordinates, monitors and evaluates the case management plan on an ongoing, appropriate basis:

1. Acts as a timely and proactive liaison between health plans, patient/family, physician(s) and FQHCs.

2. Maintains accurate record (system) of case management interventions including timely patient contacts, goal progression, and required data collection in collaboration with the Health Data Analyst.

3. Works with multi-disciplinary team to track and improve Transformation Program access and quality metrics.

4. Performs Transition of Care follow-up to patients post-acute and post Emergency Department visits

• Delivers utilization review services when patient is in active case management, as appropriate

Participates in departmental and corporate training initiatives and demonstrates evidence of continuing education

• Serves on Transformation Program Quality Oversight Committee

• Remains compliant with all accreditation, State and Federal mandates

• Provides back-up coverage for the health plans utilization review process

• Performs other job-related duties as assigned.

PATIENT CARE/AGE SPECIFIC RESPONSIBILITIES AND QUALIFICATIONS

N/A

QUALIFICATIONS/BASIC JOB REQUIREMENTS

• Graduate of an accredited school of nursing, Bachelor Degree in nursing preferred

• Current license as a Registered Nurse in the State of Illinois

• Current CPR certification required with AHA or American Red Cross

• Minimum of 3 years RN experience in a community or clinical setting required, one year of utilization review or case management experience preferred.

• Ability to communicate effectively with a diverse patient population, interdisciplinary team at Swedish, the FQHCs and the Healthcare Transformation program.

• Strong computer skills required

• Case Management or CCM certification preferred

• Managed care experience strongly preferred

• Experience working with Medicare, and Medicaid preferred

• EPIC experience preferred

• Willingness to travel regularly to FQHC sites, all within a 5 mile radius of Swedish Hospital.

• Fluency in Spanish, Urdu, Hindi, or Arabic a plus.

LICENSE/CERTIFICATION:

Current license as a Registered Nurse in the State of Illinois

Current CPR certification with the American Heart Association or American Red Cross

MANAGEMENT RESPONSIBILITY

N/A

ENVIRONMENT

1. Primary body position at work is sitting.

2. Infrequent lifting, carrying or moving of information systems equipment or supplies under 50 lbs.

3. Repetitive activities are; typing, phone use and viewing of video display devices.

Regular travel between sites.

The above statements are intended to describe the general nature and level of work performed by employees assigned to this classification and the specific functions of the individual occupying the position of.

Qualifications

Education

Required

Licenses & Certifications

Required

Equal Opportunity Employer/Protected Veterans/Individuals with Disabilities

The contractor will not discharge or in any other manner discriminate against employees or applicants because they have inquired about, discussed, or disclosed their own pay or the pay of another employee or applicant. However, employees who have access to the compensation information of other employees or applicants as a part of their essential job functions cannot disclose the pay of other employees or applicants to individuals who do not otherwise have access to compensation information, unless the disclosure is (a) in response to a formal complaint or charge, (b) in furtherance of an investigation, proceeding, hearing, or action, including an investigation conducted by the employer, or (c) consistent with the contractor’s legal duty to furnish information. 41 CFR 60-1.35(c)