Post-Acute Care Manager – Population Health

Everyone who works with Mercy Health is united under one purpose: to help our patients be well in mind, body and spirit. This drive, along with our history of faith, is a powerful combination. It gives us a shared calling to work toward every day. Join our exceptional team and help us continue to provide the highest quality of health care possible to our communities.<p><b><u>Primary Function/General Purpose of Position</u></b></p><p>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. </p><p></p><p><span class=”emphasis-3″><b>*This is a remote/work at home position. Hire must be open to working eastern time zone hours. </b></span></p><p></p><p><b><u>Essential Job Functions</u></b></p><div><div><ul><li><p>Runs daily reports for transitions of care, make assignments, and review goals of care.</p></li><li><p>Communicates at minimum weekly with skilled nursing facilities to encourage progression of care within an appropriate length of stay.</p></li><li><p>Evaluates of effectiveness of care plan with Interdisciplinary Team<span><span> </span>(IDT).</span></p></li><li><p>Conducts a comprehensive assessment and completes required <span><span>documentation.  </span></span></p></li><li><p>Performs patient outreach according to established protocols and documents in electronic medical record.</p></li><li><p>Coordinates referrals and transitions of care from one provider to another or from one care setting to another.</p></li><li><p>Provides Patient and Family or Caregiver education. </p></li><li><p>Refers to appropriate next level of care and discharge planning with facility, patient, and family or caregiver.</p></li><li><p>Conducts monthly meetings with high volume facilities on overall performance, quality, and readmissions.</p></li><li><p>Assists with standard operating procedures (SOPs) and policy development as needed.</p></li></ul></div></div><p></p><p>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.</p><p></p><p><span><span><span><b><u><span><span>Licensing/Certification</span></span></u></b></span></span></span></p><div><p><span>Current RN License in the state in which they are working or covered by compact</span>  (required)</p><p>For Roper St Francis Healthcare locations, valid drivers license and eligible for</p><p>Roper St Francis Healthcare insurance coverage (required)</p><p><span>Certification for care management (preferred)</span></p></div><p></p><p><span><span><span><b><u>Education</u></b></span></span></span></p><p>Bachelors of Science, Nursing (BSN) (preferred) </p><p></p><p><span><span><span><b><u>Work Experience</u></b></span></span></span></p><p>2 years of nursing experience (required) </p><p>1 year of experience in skilled nursing settings (preferred) </p><p></p><p><span><span><span><b><u>Training</u></b></span></span></span></p><p><span><span><span>​EPIC Electronic Health Record (preferred)</span></span></span></p><p></p><p><span><span><span><b><u>Patient Population</u></b></span></span></span></p><p><span><span><span>Demonstrates the knowledge and skills necessary to provide care appropriate to the age of the patients served on his or her assigned unit.</span></span></span></p><p><span><span><span>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.​</span></span></span></p><p><span><span><span>Adults (18-64 years)</span></span></span></p><p><span><span><span>Geriatrics (65 years and older)</span></span></span></p><p></p><p><b><u>Skills</u></b></p><p>Care Management</p><p>Regulatory and reporting standards</p><p>Clinical Documentation</p><p>Monitor patient conditions during treatment</p><p>Microsoft Office</p><p>Attention to detail</p><p>Clinical acumen</p><p>Critical thinking</p><p>Communication with family members</p><p>Teamwork</p><p>Collaboration</p><p>Active listening</p><p>EPIC</p><p>Analyzing data or information </p><p>Relationship building </p><p>Gap evaluation </p>Many of our opportunities reward* your hard work with:<br><br>Comprehensive, affordable medical, dental and vision plans<br>Prescription drug coverage<br>Flexible spending accounts<br>Life insurance w/AD&D<br>Employer contributions to retirement savings plan when eligible<br>Paid time off<br>Educational Assistance<br>And much more<br><br>*Benefits offerings vary according to employment status</b><p style=\”text-align:left\”>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 Mercy Health – Youngstown, Ohio or Bon Secours – Franklin, Virginia; Petersburg, Virginia; and Emporia, Virginia, which are Affirmative Action and Equal Opportunity Employers, please email <a href=”;. 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 <a href=”;