Posting Note: Telephonic-RN Care Manager- Remote - Phoenix As a telephonic Care Manager, you will have the opportunity to work from home utilizing your clinical expertise as you coordinate services for families that have a child in our Phoenix Children’s Care Network. Your understanding of working with insurance and payers will be a part of your role. This is not an acute care role, but rather an opportunity for you to leverage your clinical expertise as a nurse to care for PCCN patients by clearly defining the health care support available to them, assisting them in ensuring they understand the medical/healthcare process, offering them access to special programs and support services, and educating caregivers on how to care for their child with complex medical needs. Your ability to utilize your interviewing techniques to identify and anticipate the family member's medical needs for their child and troubleshooting issues for their care plan will be the role of this position. Your team will consist of Care Navigators and Social Workers. Together you will work to successfully meet the needs of the families in Phoenix Children’s Care Network. If you have experience working in measuring qualify performance or quality methodology, that will be a great asset for this role, however, this is not a requirement. Schedule: M-F 8:00 - 5:00 Location: Remote (less than 5% requirement to work on-site for an occasional meeting) 3200 Camelback, Phoenix, AZ Requirements: AZ RN License, Bachelor's Degree in Nursing, Case Management experience 3-5 years with a focus in pediatrics care management. Previous experience working with a payer, hospital, or community setting is required. If you enjoy working with your patients, via telephone, have previous pediatric and case management experience, please apply!
Care coordination is the deliberate organization of patient care activities to facilitate the appropriate delivery of health care services. This position advocates, guides and intervenes on behalf of the patient population PCCN serves in coordination with the PCP to support patients/families in understanding and navigating the health care system. Care coordination needs are identified through patient assessments and used to develop a plan of care. The plan of care identifies problems, develops goals to improve the health and well-being of patients and families, and outlines interventions to reach these goals and promote self-sufficiency. This position works closely with the rest of the Care Management Team to coordinate and track implementation of care plans, assist with problem resolution and troubleshoot barriers to care. This position works independently, receiving supervision of work activities from the Care Team Supervisor and Manager of Care Management.
- Family-Centered care that focuses on the need of the child first and values the family as an important member of the care team
- Excellence in clinical care, service and communication
- Collaborative within our institution and with others who share our mission and goals
- Leadership that set the standard for pediatric health care today and innovations of the future
- Accountability to our patients, community and each other for providing the best in the most cost-effective way.
- a) Administers Health Risk Assessments (HRAs) with patients/families who may be eligible for PCCNs care management services.
- b) Works with patient/family and other members of the care team to develop plans of care.
- c) Identifies and coordinates needed referrals for specialty care, behavioral health, community services and/or social work.
- d) Works closely with Care Navigators, assigning tasks to implement and track the plan of care.
- e) Conducts status meetings with patients/families.
- f) Monitors and evaluates patient/family success with meeting established goals and revises care plans accordingly.
- g) Makes discharge from care management determinations based on goal completion.
- h) Escalates unresolved barriers to the Care Team Supervisor or Manager of Care Management.
- i) Maintains timely, complete and accurate documentation in compliance with regulatory policies and procedures.
- j) Supports initiatives to improve quality performance against pre-defined gap in care and utilization metrics.
Interdisciplinary Care Team
- a) Cultivates and maintains effective interaction/communication with members of the interdisciplinary care team.
- b) Leads interdisciplinary care team meetings, reporting on desired and actual patient health outcomes and facilitates discussion to create action plans as necessary.
- c) Creates or approves communications sent to the interdisciplinary care team.
Transitions in Care
- a) Calls patients/families transitioning home from a hospital stay within specified time frame to monitor and support execution of the post-discharge plan of care, identify and address any additional needs with the goal of reducing the likelihood of re-admission.
- b) Supports medication compliance and treatment adherence.
- a) Maintains professional competency by regularly participating in a variety of educational programs and in-services, reviewing relevant professional publications, participating in community based committees related to service line responsibilities, and/or participating in professional societies to ensure ongoing awareness of current methodologies, practices and philosophies as applied to the patient care population.
- a) Communicates clearly in both written and verbal communications with all internal and external customers.
- b) Provides excellent service routinely in interactions with all internal and external customers.
- c) Responds to email within 24 hours or one business day.
- Performs miscellaneous job related duties as requested.