ESSENTIAL JOB DUTIES/RESPONSIBILITIES

Daily presence of team members at assigned hospitals during core hours as determined by team workflow and that team maintains a balanced caseload. Detects areas of opportunities regarding proper allocation of healthcare resources in an acute and post-acute setting. Identifies appropriateness of inpatient vs. observation status. Recognizes and manages safety risks (completes a social assessment), identifies functional status (ADLs and PT needs), discusses medications and self-management, identifies and corrects knowledge deficits. Supports, collaborates and partners with the Complex Care and Clinical Strategy Teams on the day-to-day execution of our acute care standard operating procedures. Conducts hospital bedside discussion explaining our Care Management/Disease Management program with verbal introduction to their Community Care Manager for home visit once discharge to home from either inpatient or skilled nursing facility (SNF). Implements the ACM Coaching program with the appropriate patient population. Identifies from day one (1) of hospital stay any barriers for a safe discharge back to the community. Seeks assistance from ChenMed's specialists when needed to support the care of our patients in healthcare facilities. In markets as appropriate, when patient is in SNF, in conjunction with the post-acute physician, coordinates the transition to a lower level of care as soon as appropriate using a preferred provider if further services are needed. Facilitates discharge to appropriate level of care and preferred providers. Communicates discharge to all stakeholders including patient, patient's family or designee, PCP, center leadership and Community Care Nurse. Documents the appropriate date that the patient is medically discharged and updates as appropriate. Performs Social Determinates of Health (SDoH) screening with each patient on every admission and communicates to our Community Social Workers or PCPs when a need is identified. Identifies new diagnosis during acute stay and provides PCP with documentation to review and add to patient problem list. Contacts center leadership or designee to arrange for a 4-day follow-up PCP appointment prior to discharge and whenever possible, communicates this information to the patient/caregiver. Offers and discusses with patients' the benefit of our CCM or DM programs and identify patient interest in participation as appropriate. Coordinates acute UR physician meetings. Performs other duties as assigned and modified at manager's discretion.

KNOWLEDGE, SKILLS AND ABILITIES

Strong interpersonal and communication skills and the ability to work effectively with a wide range of constituencies in a diverse community Critical thinking, organization and coordinating skills Ability to monitor, assess and record patients' progress and adjust and plan accordingly Understanding utilization review and how to leverage with inpatient staff for possible reduction of medical cost on long length of stay patients Ability to plan, implement and evaluate individual patient care plans Knowledge of nursing and case management theory and practice Knowledge of patient care charts and patient histories Knowledge of clinical and social services documentation procedures and standards Knowledge of community health services and social services support agencies and networks Ability to communicate technical information to non-technical personnel Proficient in Microsoft Office Suite products including Excel, Word, PowerPoint, and Outlook, plus a variety of other word-processing, spreadsheet, database, e-mail and presentation software Ability and willingness to travel locally, regionally, and nationwide up to 10% of the time Spoken and written fluency in English, bilingual preferred

EDUCATION AND EXPERIENCE CRITERIA

Bachelor's Degree in nursing (BSN) or RN with bachelor's degree in a related clinical field preferred A valid, active Registered Nurse (RN) license in State of employment required Compact License preferred for states where compact license is available A minimum of two (2) years' clinical work experience required A minimum of one (1) year of utilization review and/or case management, home health, hospital discharge planning experience required A minimum of one (1) year of case management experience in acute case management or community case management experience highly desired Basic Life Support (BLS) certification from the American Heart Association (AMA) or American Red Cross required within first 90 days of employment This position requires possession and maintenance of a current, valid driver's license Certified Case Manager certification is preferred. Certification through the Commission for Case Manager Certification (CCMC) or the American Association of Managed Care Nurses (CMCN) desired

PAY RANGE

$36.9 - $52.70 Hourly The posted pay range represents the base hourly rate or base annual full-time salary for this position. Final compensation will depend on a variety of factors including but not limited to experience, education, geographic location, and other relevant factors. This position may also be eligible for a bonuses or commissions.

EMPLOYEE BENEFITS

https://chenmed.makeityoursource.com/helpful-documents We're ChenMed and we're transforming healthcare for seniors and changing America's healthcare for the better. Family-owned and physician-led, our unique approach allows us to improve the health and well-being of the populations we serve. We're growing rapidly as we seek to rescue more and more seniors from inadequate health care. ChenMed is changing lives for the people we serve and the people we hire. With great compensation, comprehensive benefits, career development and advancement opportunities and so much more, our employees enjoy great work-life balance and opportunities to grow. Join our team who make a difference in people's lives every single day. 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Acute Care Manager, Complex Care (RN)