What are the responsibilities and job description for the Ambulatory Care Manager position at Bronson Healthcare?
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Position Overview
Location: Bronson Healthcare Group – Centralized Disease and Care Management
Title: Ambulatory Care Manager
Shift: First Shift
Time Type: Full Time (40 hours per week)
The Ambulatory Care Manager provides care management and coordination for adult and pediatric patients with complex health conditions in the primary care setting. This role involves collaboration with care teams, leadership, and patients/families to ensure efficient, quality-driven healthcare delivery. The Ambulatory Care Manager integrates evidence-based guidelines, preventive strategies, and personalized care plans to optimize health outcomes while focusing on reducing hospitalizations, emergency visits, and readmissions.
Key Responsibilities
Care Coordination & Management:
- Manage a caseload of complex patients, tailoring interventions to high-risk individuals.
- Identify high-risk patients through PCP referrals, risk stratification, and patient lists.
- Assess patient needs over time using standardized tools like depression screening and health risk assessments.
- Develop, implement, and monitor individualized care plans, revising as necessary.
- Provide patient self-management support and education to empower families and patients.
Clinical Interventions:
- Implement evidence-based clinical guidelines and risk stratification protocols.
- Monitor high-risk patients to prevent acute exacerbations and intervene early.
- Ensure timely follow-ups after hospital discharges, including medication reconciliation, symptom assessment, and barrier resolution.
Collaboration & Communication:
- Collaborate with PCPs, specialists, post-acute care providers, and community resources to ensure seamless care transitions.
- Serve as a liaison between patients, families, and the healthcare team.
- Foster a team-based care approach, ensuring continuity across care settings.
Process Improvement:
- Work with practice leadership to identify problems and propose care management improvements.
- Ensure care management program metrics are met and aligned with payor requirements.
Documentation:
- Maintain accurate and thorough documentation of all care management activities.
Qualifications
Education & Experience:
- Required:
- Bachelor’s degree (BSN or BS) or enrollment in a BSN program with completion within 6 months of hire.
- Two to five years of nursing experience with adult and pediatric patients in primary/ambulatory care, home health, skilled nursing, or hospital medical-surgical settings.
- Preferred:
- Experience in chronic care management, primary care, or discharge planning.
Licensure & Certifications:
- Licensed RN in good standing with the State of Michigan.
- Current CPR certification (must follow Bronson’s standards for maintaining BLS through RQI simulation).
Skills & Competencies:
- Strong assessment, triage, and critical thinking skills to analyze complex clinical issues.
- Ability to implement evidence-based interventions for chronic conditions.
- Proficient in using word processing, spreadsheets, and databases relevant to the role.
- Excellent interpersonal and communication skills to collaborate with diverse teams and patients.
- Ability to build positive relationships while maintaining professional boundaries.
- Leadership qualities, including time management, problem-solving, and decision-making.
- Adaptability to changing priorities and a commitment to continuous improvement.
Why Join Bronson?
At Bronson, you’ll find:
- A supportive, collaborative team culture.
- Opportunities for growth and professional development.
- A chance to make a meaningful impact in the lives of patients and the community.
Physical Demands
- Regularly lifts and handles materials or equipment up to 50 pounds.
- Mentally and visually demanding work requiring constant focus and problem-solving.
