Post-Acute Care Manager - Population Health

At Bon Secours Mercy Health, we are dedicated to continually improving health care quality, safety and cost effectiveness. Our hospitals, care sites and clinicians are recognized for clinical and operational excellence.

Primary Function/General Purpose of Position

The Post Acute Care Manager provides care to patients who are discharged to post-acute facilities and maintains a caseload according to productivity standards. This role performs and coordinates work with the patient, family or support members, inpatient case management team, and interdisciplinary care team members during post-acute admission for appropriate utilization of services, length of stay and safe discharge plan. The role communicates regularly on post-acute care of specific patients, as well as population level care and performance.

• This is a remote/work from home position. Hire must be open to working eastern time zone hours.

Essential Job Functions

• Runs daily reports for transitions of care, make assignments, and review goals of care.

• Communicates at minimum weekly with skilled nursing facilities to encourage progression of care within an appropriate length of stay.

• Evaluates of effectiveness of care plan with Interdisciplinary Team (IDT).

• Conducts a comprehensive assessment and completes required documentation.

• Performs patient outreach according to established protocols and documents in electronic medical record.

• Coordinates referrals and transitions of care from one provider to another or from one care setting to another.

• Provides Patient and Family or Caregiver education.

• Refers to appropriate next level of care and discharge planning with facility, patient, and family or caregiver.

• Conducts monthly meetings with high volume facilities on overall performance, quality, and readmissions.

• Assists with standard operating procedures (SOPs) and policy development as needed.

This document is not an exhaustive list of all responsibilities, skills, duties, requirements, or working conditions associated with the job. Employees may be required to perform other job-related duties as required by their supervisor, subject to reasonable accommodation.

Licensing/Certification

Current RN License in the state in which they are working or covered by compact (required)

For Roper St Francis Healthcare locations, valid drivers license and eligible for

Roper St Francis Healthcare insurance coverage (required)

Certification for care management (preferred)

Education

Bachelors of Science, Nursing (BSN) (preferred)

Work Experience

2 years of nursing experience (required)

1 year of experience in skilled nursing settings (preferred)

Training

EPIC Electronic Health Record (preferred)

Patient Population

Demonstrates the knowledge and skills necessary to provide care appropriate to the age of the patients served on his or her assigned unit.

Demonstrates knowledge of the principles of growth and development of the life span and possesses the ability to assess data reflective of the patient's status and interprets the appropriate information needed to identify each patient's requirements relative to his or her age, specific needs and to provide the care needed as described in departmental policies and procedures.

Adults (18-64 years)

Geriatrics (65 years and older)

Skills

Care Management

Regulatory and reporting standards

Clinical Documentation

Monitor patient conditions during treatment

Microsoft Office

Attention to detail

Clinical acumen

Critical thinking

Communication with family members

Teamwork

Collaboration

Active listening

EPIC

Analyzing data or information

Relationship building

Gap evaluation

As a Bon Secours Mercy Health associate, you're part of a Mission that matters. We support your well-being—personally and professionally. Our benefits are built to grow with you and meet your unique needs, every step of the way.

What we offer

• Competitive pay, incentives, referral bonuses and 403(b) with employer contributions (when eligible)
• Medical, dental, vision, prescription coverage, HSA/FSA options, life insurance, mental health resources and discounts
• Paid time off, parental and FMLA leave, short- and long-term disability, backup care for children and elders
• Tuition assistance, professional development and continuing education support

Benefits may vary based on the market and employment status.

All applicants will receive consideration for employment without regard to race, color, national origin, religion, sex, sexual orientation, gender identity, age, genetic information, or protected veteran status, and will not be discriminated against on the basis of disability. If you'd like to view a copy of the affirmative action plan or policy statement for Bon secours Mercy Health – Youngstown, Ohio or Bon Secours – Franklin, Virginia; Petersburg, Virginia; and Emporia, Virginia, which are Affirmative Action and Equal Opportunity Employers, please email [email protected]. If you are an individual with a disability and would like to request a reasonable accommodation as part of the employment selection process, please contact The Talent Acquisition Team at [email protected]