Care Manager

Key Responsibilities:

1. Care Coordination & Management

Caseload Management: Manage an assigned caseload of patients (e.g., Medicare/Medicaid beneficiaries), ensuring regular contact frequencies are met according to acuity levels.

Resource Linkage: Act as the liaison between the patient, primary care providers (PCPs), specialists, and community resources to close gaps in care.

Barriers to Care: Identify Social Determinants of Health (SDOH) such as transportation or financial issues and coordinate with social workers or community liaisons to resolve them.

Documentation: Maintain accurate, comprehensive, and compliant documentation of all patient interactions in the Electronic Health Record (EHR) in real-time.

2. Transitions of Care (TCM)

Admission/Discharge Tracking: Monitor patient census to identify hospital admissions and discharges daily.

Post-Discharge Follow-up: Conduct telephonic outreach within 2448 hours of discharge to reconcile medications, review discharge instructions, and schedule follow-up appointments with PCPs.

Red Flag Monitoring: Assess patients for worsening symptoms post-discharge to prevent unnecessary hospital readmissions (ER utilization).

3. Care Planning & Assessment

Comprehensive Assessment: Conduct telephonic clinical assessments to gather data on medical history, functional status, and psychosocial needs.

Care Plan Development: create individualized, patient-centered care plans with specific, measurable, achievable, relevant, and time-bound (SMART) goals.

Regular Reviews: Periodically review and update care plans based on patient progress, changes in health status, or after a transition of care event.

Patient Education: Educate patients and caregivers on disease processes (e.g., Diabetes, CHF, COPD), medication adherence, and self-management techniques.

Job Requirements:

Licensure & Education:

Required: Bachelor of Science in Nursing (BSN).

Required: Active and unrestricted Registered Nurse (RN) license in the Philippines (PRC).

Preferred: NCLEX passer or active US State RN License (e.g., California, New York, Texas, Florida).

Experience:

Minimum of 2 years of clinical experience in a hospital setting (Adult Medical/Surgical, ICU, or ER preferred).

Strongly Preferred: Minimum 1 year of BPO/Clinical Process Outsourcing experience servicing US Healthcare accounts (Utilization Management, Triage, or Case Management).

Familiarity with CMS guidelines, HIPAA regulations, and Value-Based Care concepts.

Skills & Competencies:

English Proficiency: Near-native English speaking and writing skills with the ability to navigate cultural nuances in US patient communication.

Tech Savvy: Proficiency in Microsoft Office (Excel, Word) and experience navigating US-based EMR/EHR platforms (e.g., Epic, Athena, Cerner, eClinicalWorks).

Critical Thinking: Ability to identify clinical red flags telephonically without physical assessment.