ACO Nurse Case Manager / St. Louis at Conifer Health Solutions

St. Louis, Missouri, USA
negotiable Expires in 5 hours

JOB DETAIL

Job description

As a part of the Tenet and Catholic Health Initiatives family, Conifer Health brings 30 years of healthcare industry expertise to clients in more than 135 local regions nationwide. We help our clients strengthen their financial and clinical performance, serve their communities and succeed at the business of healthcare. Conifer Health helps organizations transition from volume to value-based care, enhance the consumer and patient healthcare experience and improve quality, cost and access to healthcare. Are you ready to be part of our solutions?  Welcome to the company that gives you the resources and incentives to redefine healthcare services, with a competitive benefits package and leadership to take your career to the next step!
JOB SUMMARY
Reporting to Tenet leader for ACO Clinical Operations, this position will contribute to the ACO success related to improved health outcomes, increased patient engagement in self-care, and improve coordination and health care delivery through our ACOs at Tenet Healthcare.
ESSENTIAL DUTIES AND RESPONSIBILITIES
Include the following. Others may be assigned.
  • Facilitates continuity of care for patients within high risk and potentially at-risk ACO populations:

-Daily review of care management data to identify and initiate outreach
-Coordinate with patient and physicians for specific patient care needs and communication
-Complete transition of care activities for patients on the ACO care management inpatient census
-Identify patients at risk, assess to determine the level of risk (low, moderate, high) and provide recommended action and engagement to ACO patients and physicians
-Coordinate with Tenet hospital case management teams as needed for ACO member care or transition needs

  • Conducts case/disease management for patients as required and makes referrals where necessary
  • Provide telephonic outreach for assessment, and follow up to close gaps in care
  • Care coordination
  • Transition planning assessment and reassessment; implementation of the transition plan
  • Facilitating multi-disciplinary cross continuum patient care needs
  • Identifying and referring complex patients to disease management programs and community resources as needed,
  • Communicating with patients and families about the plan of care, collaborating with physicians, office staff and hospital departments,
  • Complete patient education to support health needs
  • Provide timely, complete and concise documentation
  • Identification and documentation of potentially avoidable days
  • Identification and reporting over and underutilization

Qualifications:

KNOWLEDGE, SKILLS, ABILITIES
To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
  • Population Health/Disease Management
  • Clinical assessment
  • Demonstrated organizational skills
  • Excellent verbal and written communication skills
  • Ability to lead and coordinate activities of a diverse group of people in a fast paced environment
  • Critical thinking and problem solving skills
  • Strong computer literacy
EDUCATION / EXPERIENCE
Include minimum education, technical training, and/or experience preferred to perform the job.
  • Licensed Nurse  and willing to be licensed in multiple states as applicable.
  • RN or LVN or LPN  with  at least 2 years of acute care experience required
  • Case Management Certification and/or experience preferred.
REQUIRED CERTIFICATIONS/LICENSURE
Include minimum certification required to perform the job.
  • Licensed Nurse and willing to be licensed in multiple states as applicable.
  • RN or LVN or LPN  with  at least 2 years of acute care experience required
  • Case Management Certification and/or experience preferred.
PHYSICAL DEMANDS
The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
  • Must be able to work in sitting position, use computer and answer telephone
  • Ability to travel
  • Includes ability to walk through hospital-based departments across broad campus settings, including Emergency Department environments
WORK ENVIRONMENT
The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
  • Office Work Environment
  • Hospital Work Environment
TRAVEL
  • Approximately X% travel may be required
Job:  Nursing
Primary Location:  St. Louis, Missouri
Job Type:  Full-time
Shift Type:  Days
Employment practices will not be influenced or affected by an applicant’s or employee’s race, color, religion, sex (including pregnancy), national origin, age, disability, genetic information, sexual orientation, gender identity or expression, veteran status or any other legally protected status. Tenet will make reasonable accommodations for qualified individuals with disabilities unless doing so would result in an undue hardship.

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