Job Description

Position Summary:

The Care Manager is assigned a panel of patients to manage in collaboration with primary care providers and members of the care management team. The Care Manger will educate the patients on self-care, properly accessing healthcare services, and will utilize motivational interviewing techniques. The Care Manager is also responsible for coordinating care and community services to obtain desired health outcomes, decrease cost of care, improve quality of life, and provide extraordinary patient care in the process. The Care Manager utilizes evidence-based medicine, data analytics and innovation in implementing care management principles to meet patients’ and their families' needs. 

Additionally, the Care Manager must be flexible and adapt to changes in the work environment, manage competing demands, change the approach/method to best fit the situation and be able to cope with delay or unexpected events. It is essential to take responsibility, keep commitments and complete tasks on time. Also, volunteer readily, take independent actions and ask for and offer help when needed.

Minimum Requirements:

Education:

• Graduate of an accredited school of nursing, Bachelor’s Degree (other than nursing) with an ADN or an accredited school of Social Work (MSW).

Experience:

• 3-5 years of healthcare experience in outpatient setting, population health, social services, home health, or other health care setting OR 1-3 years Care Management experience (Care Coordination, Transitions of Care, or Outpatient Case Management).

License/Registration/Certifications:

• Active SC Registered Nurse license if RN.
• Active SC Social Worker license if Social Worker.
• Valid US driver’s license with driving record with active and up to date SC car insurance.

Preferred Requirements:

Preferred Education:

• Bachelor of Nursing (BSN).
• Licensed Independent Social Worker for Clinical Practice (LISW).

Preferred Experience:

• 6-8 years of experience in outpatient setting, population health, social services, home health, or other health care setting. 
• Motivational Interviewing.
• Epic Experience.
• Health coaching.
• Chronic Condition Management.
• Home Visit Experience.
• MS Office.
• Motivational Interviewing.

Preferred License/Registration/Certifications:

• Accredited Case Manager (ACM).

Core Job Responsibilities:

• Provide telephonic or face to face outreach to engage members to assess their readiness to change by using motivational interviewing techniques to help members identify and overcome barriers that often include behavioral risk factors, such as smoking, poor health literacy, sedentary lifestyle, elevated BMI, and poor disease management.
• Coordination of referrals and transitions of care from one provider to another or from one care setting to another.
• Provide medication adherence and chronic condition education with patients and family members.
• Facilitation and/or procuring timely access to appointments and services required by patient.
• Patient and Family/Caregiver education.
• Perform facility visits, not limited to; inpatient, home, office/clinic, SNF/Rehab, within a designated time frame.
• Evaluation of effectiveness of care plan with Complex Case Review as Requested.
• Documenting and evaluating observed patient behaviors regarding medication adherence, ADL’s, social determinates of health, and their engagement in their own health care plan outlined by their specialist and primary care physicians.
• Encouraging patient directed goals and action items correlated with observed patient behaviors to impact chronic condition education, medication adherence, and the completion of Physician lead care plans.
• Assesses patient and patient's family on ability to self-engage and develops individualized patient and patient's family education plan focused on development of self-management skills based on SRHS departmental standard of care protocols.
• Identifies patients with special needs and facilitates integration of primary care with specialty and other services such as behavioral, social determinates of health, and community services where appropriate.
• Plans, develops, assesses, and evaluates care provided to specific patient populations, and engages team of care transition coach and care coordination to divide workload among team where appropriate.
• Performs analysis of the effectiveness and appropriateness of patient care plan; and modifies care plan based on assessment and evaluation.
• Communicates clear, complete, accurate, and timely documentation in a health record to ensure that all those involved in a client's care have access to necessary information to plan and evaluate their interventions.
• Updates plan of care to ensure all care team members have timely information regarding the patient's status.
• Ensure the proper handling of patient records to ensure compliance with patient health information applicable to the preservation, accuracy, and completeness of communication and/or retention of patient information, meeting all HIPAA regulations and the HITECH Act provisions as required by law.
• Must meet productivity and documentation standards set by direct supervisor.
• Ability to maintain departmental patient caseload requirements as determined by internal payor strategies and/or leadership.
• All other duties as assigned.

Get To Know Us!We invite you to reach out if you are seeking an opportunity to make a difference! Our long tenured team members are hardworking, supportive, compassionate with excellent clinical skills. We enjoy partnering with patients and their families to impact care in our community. * Sign-On Bonus Available for Eligible Roles/Experience! Are you looking for a CHANGE? We encourage you to consider relocation to Spartanburg, South Carolina (where our state motto is smiling faces, beautiful places)! We are a family friendly community located in the top 10 of most desirable places to live in the United States, number 1 place to live in South Carolina, and number 8 in the nation for millennial growth. The Upstate is located in the foothills of the Blue Ridge mountains and is rich with industry, shopping, hiking, boating, kayaking, skiing (water and snow), and foodie’s love our restaurant scene! We are close to Charlotte and not far from Atlanta with beaches less than 4 hours away. We enjoy 4 seasons and have a GREAT cost of living! Our Service Area: We proudly serve patients across:. Spartanburg, Cherokee, Greenville, and Union counties in South Carolina. Polk County in North Carolina. Ask us about our relocation assistance + Employees Discounts on apartment homes (and more!). Our Healthcare System. Spartanburg Medical Center - Church Street Campus. Spartanburg Medical Center - Mary Black Campus. Spartanburg Hospital for Restorative Care. Pelham Medical Center. Cherokee Medical Center. Union Medical Center. Ellen Sagar Nursing Center. Woodruff Manor . Medical Group of the Carolinas - 500 physician practices. Regional HealthPlus (RHP)\. Spartanburg Regional Foundation. Gibbs Cancer & Research Center. AccessHealth. The Sports Medicine InstituteSRHS is a 5-hospital system located in Spartanburg, SC. We are a teaching organization with a Level 1 Trauma designation, Bariatric Center of Excellence, Stroke Certified, Chest Pain Accreditation, Heart Failure Accreditation, CARF Accreditation, and we are hiring NOW in these specific areas: • Critical Care• ED• Cardiac• Women’s• Med-Surg• Med-Tele• Oncology• Inpatient Rehab• Hospice• Home Health

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