Care Manager II
Posted on: November 11, 2019
We're a Little Different
Our mission is clear. We bring to life a healing ministry through
our compassionate care and exceptional service.
We don't believe in jobs at Mercy, we believe in careers that match
the unique gifts of unique individuals; careers that not only make
the most of your skills and talents, but also your heart.
At Mercy, you'll feel our supportive community every step of your
day, especially the tough ones. We're a team and love working that
way. That team is expanding, and we currently have exceptional
opportunities to help our communities grow.
The Care Manager facilitates transition of care planning with an
interdisciplinary healthcare team to achieve quality outcomes,
reduce costs and ensure patient safety.
Actively supports Care Management plans and processes to measure,
assess and improve quality, resource management, patient outcomes
and Care Management metrics.
* Reports to Care Management leadership, the identification of
avoidable days and other Care Management measures including, but
not limited, readmissions, saved days, core measure monitoring,
interventions, and delays, to ensure data is accurately
* Implements strategies in collaboration with the healthcare team
to reduce length of stay (LOS) and resource utilization, never
compromising quality or outcomes.
* Ensures patients are in the appropriate LOC according to
evidenced based, physician approved criteria and standards and
prescribed plan of care
* Ensures authorizations for post acute services are obtained in a
* Facilitates denial management of post acute services
Facilitates the discharge planning process to ensure patient
throughput by (add) collaborating with the healthcare team.
* Prioritizes patient's need for Care Management services based on:
target/high volume Diagnosis-Related Group (DRG), high cost,
outlier, LOS, frequent inpatient admissions, unplanned readmission
or significant variance.
* Identifies risk factors for potential crisis intervention needs
related to clinical diagnosis, prognosis and/or patient/family
* Identifies and reports ethical situations to manager/supervisor
and Ethics Committee for resolution.
* Ensures the multidisciplinary discharge plan is consistent with
the patient's clinical course, continuing care needs and covered
services. Evaluates on an ongoing basis the patient's status and
progress toward reaching goals set forth in the plan of care.
* Supports the patient/family decision regarding advance directives
or verifying a surrogate decision maker.
* Works collaboratively to assess for clinical, spiritual,
financial, educational, functional and psychosocial baselines for
patient/family to determine appropriate and realistic outcomes.
* Educates patient/family/support system on the plan of care and
expected outcomes. Improves patient/family understanding of and
adjustment to the medical diagnosis/prognosis or other care
Emergency Department (ED) Care Management
* Identifies target patient populations most likely to have
discharge needs such as but not limited to Primary Care Physician
(PCP) Identifies Level of Care (LOC) needs and facilitate discharge
planning elderly, chronically ill, underserved, limited or
ineffective support system, polypharmacy issues, no Primary Care
Physician (PCP) Identifies Level of Care (LOC) needs and facilitate
discharge planning of appropriate patients treated ED; thereby
reducing ED re-visits or subsequent admissions.
* Identifies the appropriate LOC (Inpatient, Outpatient Observation
Stay) and collaborates with the attending Physician as
* Identifies and provides community resources to ensure a safe
transition of care.
Communicates effectively and provides education.
* Collaborates with patients, families and other members of the
healthcare team to facilitate care coordination.
* Handles complaints/concerns in a prompt and courteous manner;
assesses and directs to appropriate person to deal with concerns as
* Care Manager provides patient and family education as it relates
to discharge plan.
Portrays a positive professional public image at all times.
* Consistently works toward standards of excellence to continually
improve personal performance.
* Develops professional relationships with community partners.
* Builds and maintains positive, professional relationships with
the healthcare team, placing organizational/team goals first.
* Assumes responsibility, authority and accountability for assigned
work, seeks to assist team members and identifies opportunities for
* Documents data accurately in the electronic medical record and
applicable programs to ensure data for tracking and trending is
* Maintains technical knowledge and skills of computer and
integrated software systems.
* Maintains current knowledge of online verification/
precertification process with insurance carriers.
If applicable to care management facility:
Swing Bed Program
* Maintains established policies and procedures and updates them
annually or as needed.
* Responsible for evaluation of patient appropriateness for
placement prior to admission to Swing Bed status and
appropriateness for continued rehab stay.
* Provide inservices as needed to the Medical/Surgical staff on
subjects relating to care of Swing Bed/LTC patients.
* Responsible for provision of Social Activities for Swing Bed
* Works with patients and families concerning optimal care of
patient on the continuum.
Provides Swing Bed patients with the Medicare Notice of
Non-Coverage at least 2 days prior to discharge.
Other: Performs other duties as assigned
Because you're committed to excellence, you understand the
importance of being properly prepared for your role at Mercy.
That's why you'll bring to your role the right set of
- Graduate of an accredited School of Nursing, Required
- Bachelor's Degree of Science in Nursing, Required
- Current License in the state of employment, Required
- 2-3 years acute care hospital setting, Required
- Care Management or Utilization Management experience,
- BLS (CPR) at hire date, Minimum Required, or within 90 days of
- Certification in Case Management, Preferred
Other Skills & Knowledge
- Strong verbal and written communication and facilitation skills,
- Strong assessment skills, time management skills, critical
thinking skills, Minimum Required
- Advanced computer skills, Minimum Required
- Must have ability to interact effectively with a variety of
people and situations at all levels of the organization, Minimum
- Knowledge of InterQual criteria, Preferred
We'll Support You at Work and Home
Our foundations are built on dignity and respect. Modern Healthcare
Magazine named us as a "top 100 places to work." We go out of our
way to help people feel welcomed. We offer day-one comprehensive
health, vision and dental coverage, PTO, tuition reimbursement and
employer-matched retirement funds to benefit-eligible co-workers,
including those working 48 hours or more per pay period!
What Makes a Good Match for Mercy
Compassion and professionalism go hand-in-hand with us, along with
exceptional quality care. Having a positive outlook and a strong
sense of advocacy is in perfect step with our mission and vision.
We're also collaborative and are not afraid to do a little extra to
deliver excellent care - that's just part of our commitment. If
that sounds like a fit for you as well, we encourage you to
Mercy has determined this is a safety-sensitive position. The
ability to work in a constant state of alertness and in a safe
manner is an essential function of this job.
Keywords: Mercy, Springfield , Care Manager II, Executive , Springfield, Missouri
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