Care Manager, Registered Nurse - Hybrid Remote - Med Surg

Company: Sharecare
Location: Washington
Posted on: March 20, 2023

Job Description:

Care Manager, Registered Nurse - Hybrid RemoteJob Description:

Sharecare is the leading digital health company that helps people -- no matter where they are in their health journey -- unify and manage all their health in one place. Our comprehensive and data-driven virtual health platform is designed to help people, providers, employers, health plans, government organizations, and communities optimize individual and population-wide well-being by driving positive behavior change. Driven by our philosophy that we are all together better, at Sharecare, we are committed to supporting each individual through the lens of their personal health and making high-quality care more accessible and affordable for everyone. To learn more, visit www.sharecare.com.

Job Summary:

The Care Manager (CM) supports the implementation of the CareFirst Patient-Centered Medical Home (PCMH) program by working with members who are attributed to a PCMH Primary Care Physician. The CMs works with Primary Care Physicians (PCPs), Specialty Care Providers and regional support teams. The Care Manager will advocate, guide and intervene on behalf of their members to ensure successful completion of Care Plan goals, while providing Complex Case Management and strategies for health self management through the duration of the Care Plan. The CM acts as the primary interface between the CareFirst program and individual primary care providers (PCPs), Specialist and their patients (members).

* This position will require a Covid-19 vaccination.

Essential Job Functions:

* Develop and maintain strong working relationships with PCPs, Specialists and other clinicians to integrate the PCMH program into their practices.
* Serves as an extension of the PCP office for PCPs who participate in the PCMH Program.
* Provide telephonic and, when appropriate, on-site consultation to PCP and Care Coordination Team providers related to implementation of the PCMH model including development and documentation of Care Plans for individual members, inclusive of tracking processes, member self-management support, implementation of clinical practice guidelines and work process/patient flow improvements.
* Follow-up with parties as appropriate
* Collaborate with PCPs, Members and Specialty Providers in the development, documentation and implementation of Care Plans and delivery of coordinated services for members identified through this CareFirst program.
* Facilitates and monitors the transition of care which involves moving the member from one healthcare practitioner and setting to another as their healthcare needs change. Implements and oversees the agreed upon plan of care in conjunction with member's PCP and other providers.
* Coordinates member follow-up post discharge for applicable transitions.
* Maintain the electronic Care Plan.
* Utilize established documentation standards to maintain quality of Care Plan documentation to include member progress toward their established state of being and barriers to achievement of Care Plan objectives/outcomes.
* Develop communication and referral mechanisms to assure that there is seamless communication between PCMH, PCPs, Specialists and the Care Coordination Team.
* Abides by PCMH Program Description and Guidelines.
* In conjunction with Regional Care Directors and PCMH Practice Consultants, develops clinical reports for use in PCP office, facilitating PCP support of members in behavior change.
* Assist the member in coordination of any additional tests, images and consults with specialists as deemed appropriate by the PCP or Specialist. For selected members with multiple prescriptions, perform a comprehensive medication reconciliation (CMR) at the onset of the Care Plan, as well as every thirty days during the life of the Care Plan, or when any medication is changed, added or deleted, assessing for efficacy and drug interaction/side effects.
* Identifies appropriate program partners and other healthcare providers/vendors as well as Community Resources.
* Refers and follows-up on referrals and results.
* Assesses the member's ongoing care needs and progress towards goals throughout the case duration and makes revisions as needed to address changes in the member's condition, lack of progress toward goals of the care plan, preference changes, and transitions in care settings.

Coordinates plan of care with the provider with goals of member stabilization, decreased admissions and medication management.

* Direct the PCP to the Program Consultant or Regional Care Director when he/she identifies an opportunity for education or additional learning needs surrounding the program that are outside of his/her understanding.
* Coordinate patient education in support of standards of care guidelines and related health issues using the most appropriate modality for the member.
* Facilitate the completion of member satisfaction surveys, Patient Activation Measures (PAM) and Post-PAM graduation.
* Verbally or physically connect with each member every week.

o Maintain member encounter rates of 100%; and

o Provide effective coordination of care.

* Completes mandatory training.
* Actively participates in team huddles and contributes to the clinical learning
* Keeps current on clinical knowledge via self-directed learning

SCOPE DATA:

Care Managers are the face of CareFirst in provider offices, interacting directly with CareFirst members face-to-face and telephonically. Like other RNs providing care coordination, Care Managers must be fully versed in all aspects of PCMH and TCCI in order to incorporate the TCCI elements into effective and successful Care Coordination.

Specific Skills/ Attributes:

* Demonstrates ability to be self-directed, highly organized, multi-tasked capable, and proficient in problem solving skills.
* Demonstrates exceptional oral, written, and presentation skills.
* Demonstrates success in influencing patients and providers. Outstanding customer service skills and ability to adapt approach to various personalities.
* Demonstrates ability to work effectively with all levels of administrative and professional personnel.
* Demonstrates proficiency with data analysis and ability to organize data in support of reporting needs.
* Demonstrates ability to proactively identify and assimilate quality improvement processes into practice.
* Ability to extrapolate information from a variety of sources including medical records to create concise records that accurately depict the medical "story" of the member.
* Comfort with managing multiple tasks and continually re-prioritizing.
* Experience with medically oriented care plan documentation.
* Experience working effectively within a matrix organizational design.
* Must demonstrate resilience and effectively work in a fast-paced environment with frequently changing priorities, deadlines, and workloads that can be variable for long periods of time.
* Must be able to meet established deadlines and handle multiple customer service demands from internal and external customers, within set expectations for service excellence.
* Must be able to effectively communicate and provide positive customer service to every internal and external customer, including customers who may be demanding or otherwise challenging.

Qualifications:

* Healthcare background and current licensure as a Registered Nurse is required. BSN preferred.
* Minimum 3-5 years clinical experience in any of these areas: acute care, home health, physician office management, managed care organization, provider relations, pharmaceutical sales.
* Demonstrates computer competencies to include word processing, spreadsheet, presentation preparation, and data base management.
* Demonstrated ability to learn customized computer applications.
* Maximize all technology inclusive of Guiding Care, Microsoft Teams, Microsoft Word, Microsoft Excel, Microsoft Outlook, laptop computers, and all other relevant CareFirst unified communication technologies.
* Has valid driver's license and driving record showing no restrictions that would impede ability to travel by automobile.
* Travel Requirement: 30-40% (variable) by own auto

Sharecare and its subsidiaries are Equal Opportunity Employers and E-Verify users. Qualified applicants will receive consideration for employment without regard to race, color, sex, national origin, sexual orientation, gender identity, religion, age, equal pay, disability, genetic information, protected veteran status, or other status protected under applicable law.

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