Job Description

The Care Manager strives to promote patient wellness through evidenced based practice, improved care outcomes, efficient utilization of health services, and minimizing care denials from payer sources. The Care Manager is a coordinator, facilitator, educator and impartial advocate. The underlying Care Management objectives are: enhancing the quality of clinical outcomes and patient satisfaction, while managing the cost of care.

The Care Manager, in collaboration with physicians, Medical Social Workers and other interdisciplinary team members, provides: patient care coordination, care facilitation and planning, and transition of care or discharge planning.

The Care Manger performs pre-admission, initial, continued stay, and discharge assessments to assure that the patient’s care is provided at the appropriate level or status. This is done in compliance with requirements from multiple different regulatory bodies. These assessments help to ensure that the patient’s care is not only appropriate, but also that it is reimbursed by the different payer sources.

Qualifications

EDUCATION:

Graduate of an approved school of nursing; holds and maintains current Registered Nurse license for the State of West Virginia

BSN, BSHCA MSN, MHA or MBA preferred, not required. Certification in Care Management preferred.

EXPERIENCE:

Should have a minimum of five (5) years nursing experience. Minimum of (1) year of Care Management or Utilization Management and discharge planning experience highly preferred.

SKILLS:

Demonstrates competence in leadership skills. Should maintain skills in order to relate ongoing changes in hospital and community-based care management BCLS Required.