- Facilitates coordination and arrangement of post-acute services such as home health, hospice,recuperative care, skilled nursing facility care for the patient in the ambulatory setting.
- Works with multiple members of the care team including external stakeholders to perform warm hand offbetween people functions and sites to ensure patients receive appropriate and timely services byclosing the loop on referrals and motivating/teaching patents and their care giver when and where toseek care.
- Uses a defined process to identify patients in need of post-acute care coordination services to facilitatecare transitions and wellness activities for patients referred with the goal of enhancing patient healthand well- being, improving adherence to the plan of care and reducing health care costs.
- Participates in interdisciplinary team meetings helping to ensure patients are meeting milestones andprogressing toward their healthcare goals.
- Ensures patient understanding of care plan, resolves patient inquiries within scope, and escalates patientinquiries and health concerns beyond scope to the RN Case Manager or following/ordering provider.
- Under RN Case Manager Supervision, case manages caseload of patients, including implementingaction plans and utilizing tracking tools, providing education, navigation, patient/family support andcoordinating with other care provider's resources.
- Serves as a patient advocate and represents the department for the purposes of enhancing communityawareness of available services through sharing of information and education.
- Documents activities that support the Care Management process.
- Informs the Case Managers of changes in the patients' status that could impact positive patient outcomesor achieving desired goals.
- Identifies need for advanced directive assistance and reports findings to Nurse Case Manager or SocialWorker.
- Precepts newly hired Post- Acute Care Management Specialists, assist with quality improvementactivities and participate in special Case Management projects.
- Performs delegated case management and department operational duties.
- Local travel may be required to perform duties at multiple sites.
- Job description is not an all-inclusive list of duties and may be subject to change with or without notice.Staff are expected to perform other duties as assigned.
- Graduate of a state approved school of Vocational Nursing
- 4 years of LVN experience in home health, hospice, community health or public health setting (clinic,provider offices).
- Current LVN licensure by the Board of Nurse Examiners for the State of Texas or proof of reciprocity oflicensure between the State of Texas and another state.
- 4 plus years Case Management or LVN experience in home health, hospice, hospital, clinic, skillednursing facility, community or public health setting.
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Care Management Specialist - Fort Worth, United States - JPS Health Network
Description
Who We AreJPS Health Network is a $950 million, tax-supported healthcare system in North Texas. Licensed for 582 beds, the network features over 25 locations across Tarrant County, with John Peter Smith Hospital a Level I Trauma Center, Tarrant County's only psychiatric emergency center, and the largest hospital-based family medical residency program in the nation. The health network employs more than 7,200 people.Acclaim Multispecialty Group is the medical practice group featuring over 300 providers serving JPS Health Network. Specialties range from primary care to general surgery and trauma. The Acclaim Multispecialty Group formed around a common set of incentives and expectations supporting the operational, financial, and clinical performance
outcomes of the network. Our goal is to provide high quality, compassionate clinical care for every patient, every time.
Why JPS?We're more than a hospital. We're 7,200 of the most dedicated people you could ever meet. Our goal is to make sure the people of our community get the care they need and deserve. As community stewards, we abide by three Rules of the Road:
1. Own it. Everyone who wears the JPS badge contributes to our journey to excellence.
2. Seek joy. Every day, every shift, we celebrate our patients, smile, and emphasize positivity.
3. Don't be a jerk. Everyone is treated with courtesy and respect. Smiling, laughter, compassion - key components of our everyday experience at JPS.
When working here, you're surrounded by passion, diversity, and dedication. We look forward to meeting you
For more information, visit
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Job Title:
Care Management Specialist
Requisition Number:
34572
Employment Type:
Full Time
Division:
CLINICAL INTEGRATION
Compensation Type:
Hourly
Job Category:
Nursing / LVN
Hours Worked:
Mon-Fri 8A-4:30P
Location:
South Campus Health Center
Shift Worked:
Day
Job Description:
Job Summary: The Care Management Specialist coordinates integrated care delivery across the care continuum toimprove clinical outcomes, reduce admission risk and promote effective utilization of health careresources within JPS Health Network. The Specialist serves as a patient liaison to assist in arrangingservices to yield a seamless transition between care settings with emphasis on the outpatient setting andpost-acute services. The Care Management Specialist works in collaboration and continuous partnershipwith patients and their family members, as well as clinic, hospital, post-acute and insurance partners,along with community resources, to achieve the desired outcomes while providing continuity of care.
Essential Job Functions & Accountabilities:
Required Qualifications:
2500 Circle Drive
Fort Worth, Texas, 76119
United States