Population Health Case Manager
Job ID: 83022
Area of Interest: Nursing
Location: Linthicum,MD US
Hours of Work: 8a – 4p
Job Facility: University of Maryland Medical System
Employment Type: Full Time
What You Will Do:
The University of Maryland Medical System is a 14-hospital system with academic, community and specialty medical services reaching every part of Maryland and beyond. UMMS is a national and regional referral center for trauma, cancer care, Neurocare, cardiac care, women’s and children’s health and physical rehabilitation. UMMS is the fourth largest private employer in the Baltimore metropolitan area and one of the top 20 employers in the state of Maryland. No organization will give you the clinical variety, the support, or the opportunities for professional growth that you’ll enjoy as a member of our team. UMMS is currently seeking a Population Health Case Manager for our Corporate offices in Linthicum, MD.
Under supervision of the Case Management Leadership, will manage and oversee the comprehensive assessment, planning, implementation, monitoring, and overall evaluation of individual patient needs. A Case Manager assists in identifying appropriate providers and facilities throughout the continuum of services, while ensuring that available resources are being used in a timely and cost-effective manner in order to obtain optimum value for both the patient and the reimbursement source. A Case Manager will provide care management and coordination of care for patients across various diseases. A Case Manager will focus on achieving patient wellness and autonomy through advocacy, communication, education, identification of service resources and service facilitation. Overall, the Case Manager will promote direct communication with the patient, and appropriate service personnel, in order to optimize outcomes.
Principal Responsibilities and Tasks
The following statements are intended to describe the general nature and level of work being performed by people assigned to this classification. These are not to be construed as an exhaustive list of all job duties performed by personnel so classified.
- Demonstrate critical thinking skills when utilizing the nursing process, based on research, evidence-based outcomes and Standards of Practice to meet patient’s health care needs.
- Gathers and analyzes specific criteria and guidelines to track inpatient admissions in and out-of-network, ED, readmission and high cost utilization of members associated with UMQCN/UMMS providers.
- Create population-based management strategies and processes (based on a solid understanding of care management, including disease management and preventive care) that help patients manage their healthcare needs and foster care quality, cost-effectiveness, and patient engagement.
- Recognizes/understands responsibility of this key role and the responsibility this position demands in direct support of high quality patient care delivery regardless of assignment. This will be measured by the accountability/initiative taken in the performance of daily duties and assignments as itemized in major accountabilities section of job description.
- Establish collaborative partnerships with patients to assist them in examining patterns of health care needs, decisions, lifestyle choices, and utilization of resources that affect their health.
- Be attentive to detail to maintain accurate and timely data exchanges among all entities involved in the patients’ care
- Consult with other external agencies to provide support services and resources
- Communicate effectively with patients, physicians, and their staff on a regular basis.
- Delegates and oversees the care management of lower-risk patients as well as routine chronic disease population management tasks to assigned caregivers.
- Participates in monthly chart audits.
- Performs special projects as assigned.
- Ensures compliance with all state and federal regulations and guidelines in day-to-day activities.
- Demonstrates leadership, mentorship and teamwork within dedicated care teams including clinicians, chronic disease care coordinators, medical assistants, pharmacists, social workers and others
- Performs other duties as assigned
What You Need to Be Successful:
Education and Experience
- Licensure as a Registered Nurse in the state of Maryland, or eligible to practice due to Compact state agreements outlined through the MD Board of Nursing, is required; BSN preferred.
- 3 to 5 years of care coordination experience and/or experience working in an outpatient ambulatory setting
- Experience with educating patients and patient goal setting (essential)
- Case Management Certification (preferred)
- Experience in a manage care information environment (preferred)
- Preferred experience would include knowledge of quality improvement processes (LEAN or PDSA); practice re-design work such as patient centered medical home and Joint Commission and National Committee for Quality Assurance (NCQA) accreditations
We are an Equal Opportunity/Affirmative Action employer. All qualified applicants will receive consideration for employment without regard to sex, gender identity, sexual orientation, race, color, religion, national origin, disability, protected veteran status, age, or any other characteristic protected by law.
We are an Equal Opportunity / Affirmative Action employer. All qualified applicants will receive consideration for employment without regard to sex, gender identity, sexual orientation, race, color, religion, national origin, disability, protected veteran status, age, or any other characteristic protected by law. EEO IS THE LAW
- Follow us on