Advanced Heart Failure Care Manager

aah; South Carolina; On-site; USD 53,000 - 79,000; Full time

Job summary

aah is seeking a Clinical Care Manager in Greenville, SC for a full-time role in Surgery Transplant: Heart. The position requires an RN license, a Bachelor’s in Nursing, and 5 years of clinical nursing or 1–2 years in care management.

Expect a 40-hour work week, M-F, 8am-5pm, with pay range $38.20 - $57.30 per hour and benefits eligibility. The role emphasizes coordinating patient care across multidisciplinary teams, ensuring quality and cost-effective outcomes, and supporting patient activation

Qualifications

• RN licensure required in the state of practice.
• Bachelor's Degree in Nursing or related field.
• Typically 5 years of clinical nursing or 1–2 years in care management.

Responsibilities

• Facilitates communications among patient/family and care teams to resolve barriers to timely care.
• Collaborates with primary care and hospital teams to ensure quality, efficient care.
• Uses evidence-based approaches to activate and engage patients in their care.
• Manages CM caseload independently and completes tasks in a timely manner.
• Coordinates referrals and information flow for smooth transitions of care.

Skills

Communication skills

Critical thinking

Provider collaboration

Education

Bachelor's Degree in Nursing

Tools

Epic EMR

Microsoft Office

Job description

Department:

02422 GCMG SHVI: Greenville - Surgery Transplant: Heart

Status:

Full time

Benefits Eligible:

Yes

Hou rs Per Week:

40

Schedule Details/Additional Information:

M-F 8am-5pm

Pay Range:

$38.20 - $57.30

Major Responsibilities:

• Facilitates communications among patient/family, multidisciplinary team, medical management team, community resources and other disciplines to anticipate, identify, evaluate, and act to resolve any potential barriers and constraints to delivery of care in a timely manner. Understands and interprets multiple contracts and contractual obligations in order to enable the care management team to achieve maximum clinical and financial outcomes.
• Collaborates with the patient/family and inter-professional team including the primary care team, hospital care team, post acute care managers, and other care partners to provide a model of care that ensures the delivery of quality, efficient, and cost-effective healthcare services. May work embedded within a provider office or telephonically working with a care team.
• Uses evidenced-based approaches to increase patient and family activation and engagement in their own care. As appropriate to the population, partners with patient and family to develop SMART (specific, measurable, attainable, relevant, time-bound) goals. Assists in the development, procurement, and adoption of patient self-management educational resources.
• Identifies potential barriers to learning and/or to the optimal delivery of care. Reports abnormal findings to the responsible provider/care team, and collaborates to develop a plan.
• Independently manages CM caseload according to department expectations. Ensures timely completion of tasks and documentation related to MCO, regulatory and contractual requirements.
• Partners with identified at-risk patients throughout the diagnosis, treatment and follow-up in order to deliver continuity of care. Anticipates the needs of the patient, recognizes and responds to changes in a patient's status and determines priorities of patient care based on essential patient needs.
• Coordinates patient information and communication between and among the patient/family, the referring/accepting facilities and physicians, community caregivers (as applicable) and other members of ACM to ensure smooth transitions of care.
• Coordinates referrals to other internal AAH departments and/or external community resources as necessary.

Licensure, Registration, and/or Certification Required:

Registered Nurse license issued by the state in which the team member practices.

Education Required:

Bachelor's Degree in Nursing or related field.

Experience Required:

Typically requires 5 years of experience in clinical nursing or 1-2 years of care management experience.

Knowledge, Skills & Abilities Required:

• Applicable certification is encouraged.
• Must be self-directed with the ability to work well independently and within a team environment while recognizing and meeting the individual needs of external and internal partners/customers.
• Ability to demonstrate excellent oral, written and interpersonal skills.
• Ability to demonstrate critical thinking, problem solving and excellent organizational skills.
• Ability to work productively and effectively in a complex environment that includes multiple changing priorities.
• Demonstrated ability to work well with physicians and other healthcare professionals in a direct and positive manner.
• Proficient computer/Microsoft-suite skills and previous Epic EMR experience.
• Ability to handle multiple responsibilities.

Physical Requirements and Working Conditions:

Position may require travel between clinic sites so there may be exposure to road and weather conditions.Manual dexterity required for operation computer and calculator.Visual acuity required to facilitate review of written documents/computer screens, medical records, and to record information accurately.Clear oral communications and hearing acuity required for receiving instructions and converse on standard telephone.Functional speech and hearing to allow for effective communication of instructions and conversation over the telephone.Exposed to normal office environment; including usual hazards related to operating electrical equipment.Operates all equipment necessary to perform the job.

This job description indicates the general nature and level of work expected of the incumbent. I