Ambulatory & Transitional Case Manager
Location: Burlington Massachusetts
Description: Lahey Health is hiring Ambulatory & Transitional Case Manager right now, this occupation will be placed in Massachusetts. For complete informations about this occupation opportunity please read the description below. Responsibilities Clinical Judgment and Decision Making: Ways in which nurses come to understand the problems, issues or concerns of patients/families, ! to attend to relevant/critical information, and to respond in concerned and involved ways.
The Ambulatory and Transitional Case Manager is expected to and is accountable for providing safe patient care by demonstrating organizational skills that maintain and coordinate safe delivery of quality care for assigned patients/families.
Develops a culturally competent plan of care that identifies patient problems, expected outcomes, and addresses preventative measures.
Delivers care that is specific to the age of the patient.
Evaluates effectiveness of care and adapts plan based on patient/family response.
Professional Relationship: The professional relationship is based upon Lahey Clinics guiding principles and positive effective communication. This relationship extends beyond formal assessment to integrate the particular patients response and his/her religious/spiritual, ethnic and cultural beliefs into the plan of care. Establishes professional relati! onship with nurses, physicians and other colleagues and patien! ts and families.
Supports Lahey Clinics commitment to community based activities both within the Lahey community and beyond.
Clinical Leadership: The Ambulatory and Transitional Case Manager supports the development of others and creates a practice climate of responsiveness and learning. This supports the retention and recruitment of clinically competent nurses. The ability to lead and influence the reasoning of colleagues in the patients best interest depends on skillful comportment, authoritative clinical knowledge and wisdom, the conviction to act as an ethical agent despite adverse consequences, and the ability to listen and enhance others strengths. Demonstrates professional behavior by adhering to unit policies and procedures, practice guidelines specific to the setting and the ANA Code of Ethics.
Demonstrates skills as a responsive team member.
Demonstrates clinical leadership as evidenced by supporting research and development of clinical! pathways.
Demonstrates role of nurse as teacher.
Demonstrate ability to fulfill role in Regulatory compliance and readiness.
Case Management: Coordinates care for identified patients across the continuum in collaboration with physicians and all members of the health care team Serves as the liaison with patients, families to physicians, clinical staff, inclusive of Inpatient Case
Managers, and other departments within Lahey, 3rd party insurers involved with patient care, and community and post-acute care providers.
Advocates for patient and families, responds to and facilitates resolution of patient questions and concerns.
Conducts comprehensive clinical assessments that include the age-specific, medical, behavioral, pharmacy and social needs of each patient. Shares this information with the healthcare team and with the patient. Uses this information to develop and maintain a customized, patient-specific care plan incorporating the patient and! family in the development of the plan.
Partners with patients and ! families on self management support including: Sets short and long-term goals for self-management of chronic disease to include acute exacerbation management.
Performs reassessment in patient progress toward goals and alters plan of care as appropriate.
Works with patient to create a plan for health behavior change.
Assesses and works with the patients readiness to change, the importance of change, and confidence in ability to change.
Helps the patient to identify and overcome barriers.
Provides or arranges needed patient education regarding specific health care skills and general disease concepts.
Identifies patients overdue for visits, labs, in need of referrals, or admitted to emergency room, inpatient, sub-acute facilities or VNA, and arranges for follow-up services as appropriate.
Identifies patients not meeting established goals and arranges for follow-up services by clinical pathway or as appropriate.
Works independently to assess and ! evaluate the patients understanding of disease process, treatment plan lifestyle changes, and recognize changes in patients condition.
Optimizes patients experience with provider visits: conducts pre-visit chart review of patients using resources including the disease registry, identifies all needed preventive health maintenance, immunizations, chronic disease Interventions, completes pre-visit forms or initiates office visit forms to communicate the review to the provider, assists with shared medical appointments, communicates in person in the office setting by telephone and/or by e-mail as the patient needs, communicates regularly with treating clinicians and other members of the health care team.
Utilizes the disease registry database including: Updates database as appropriate,
creates patient, physician, and clinic level quality performance reports.
Participates in quality improvement activities aimed to improve patient-population outcomes ! and associated processes.
Assesses clinic needs and collaborates wi! th Clinic/Site manager on strategies to achieve individual clinic level goals, such as quality and efficiency.
Actively participates / coordinates committees as needed / requested; i.e., Performance Improvement Teams.
Communicates and coordinates with the healthcare team in the development of tools for optimal patient outcomes and report findings.
Meets with other Lahey Ambulatory and Transitional Case Managers as indicated by Clinic Administration for standardization in practice, information sharing and continuing education activities.
Interacts with case managers and other providing care for the patients in their panel, throughout the continuum of care to include acute hospital, skilled nursing facility, and acute inpatient rehabilitation. The ACM will be responsible for insuring the transitions of care are handled well and the needs of the patient are anticipated and meet.
Will respond to Payer requests for clinical information needed to certify an ad! mission and reimburse for services, by providing appropriate clinical information within one business day of the request; documents communication with payer.
Will work with the Stop Loss Carriers to effectively management High Dollar Claims.
Monitors and identifies problems of inappropriate utilization of resources.
Make referrals as needed to the Medical Director.
Assists with appeal of services denied.
Utilize all appropriate screening criteria (Interqual; Milliman) when reviewing medical records, either by book and/or on-line.
Reviews observation admissions for appropriateness
Additional Duties and Responsibilities: Achieves and maintains Certification as a Case Manager within one year of employment.
Organizational Requirements:
Maintain strict adherence to the Lahey Hospital and Medical Center Confidentiality policy.
Incorporate Lahey Hospital and Medical Center Standards of Behavior and Guiding Principles into ! daily activities
Comply with all Lahey Hospital and Medical Center ! Policies..
Comply with behavioral expectations of the department and Lahey Hospital and Medical Center.
Maintain courteous and effective interactions with colleagues and patients.
Demonstrate an understanding of the job description, performance expectations, and competency assessment.
Demonstrate a commitment toward meeting and exceeding the needs of our customers and consistently adheres to Customer Service standards.
Participate in departmental and/or interdepartmental quality improvement activities.
Participate in and successfully completes Mandatory Education.
Perform all other duties as needed or directed to meet the needs of the department. Qualifications Education: Bachelor of Science in Nursing
Licensure, Certification & Registration: Licensed RN in the Commonwealth of Massachusetts. BLS certification.
Experience:
A minimum of 5 years medical/surgical or ambulatory clinic nursing required.
S! kills, Knowledge & Abilities: Demonstrates expert practice skills that include flexibility, priority setting, problem-solving, conflict resolution, negotiating and networking skills, decision making, work delegation and organization, and verbal / written communication skills.
Demonstrates effective teaching techniques applying adult learning principles.
Demonstrates ability to coordinate appropriate educational materials for patients and their support systems.
Demonstrates sound knowledge bases and actions in the decision making process for designated patient populations.
Responsible for following equipment maintenance protocol, identifying problems, and coordinating appropriate repairs.
Answers and routes multiple phone calls and faxes, tasks and directs messages and information pertinent to chronic disease management.
Receives and arranges appointments for providers and patients for patient meetings, procedures, and appointments and sends corre! spondence as designated.
Adheres to all insurance, contractual and r! egulatory requirements as mandated.
Excellent interpersonal and organizational skills. Shift DAYS About Lahey Clinic At Lahey Clinic, as one of the world's premier health care organizations, we provide superior health care leading to the best possible outcome for every patient. We exceed our patients' high expectations for service each day. We also help advance medicine through research and the education of tomorrow's health care leaders
We care for our patients with compassion and openness, unsurpassed expertise, a drive for continuous learning improvement, and with respect, caring, teamwork, excellence and commitment to doing our personal best.
Join our team and our mission of excellence by applying today! How To Apply Please apply directly online at http://www.lahey.org/careers. Use the Job ID number to quickly locate the appropriate job listing. Once you have located the desired job, click on the checkbox in the 'Select' column, and then click the ! 'Apply Now' button, located at the bottom of the screen. Please note you are only able to select 5 jobs at a time.
Lahey Colleagues please apply directly through Colleague Connection using your MR1 Login and Password.
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If you were eligible to this occupation, please email us your resume, with salary requirements and a resume to Lahey Health.
If you interested on this occupation just click on the Apply button, you will be redirected to the official website
This occupation starts available on: Thu, 04 Jul 2013 13:01:12 GMT