What are the responsibilities and job description for the RN Care Transition/Implementation Manager position at Care New England?
Job Summary:
The Integra Transition Manager partners with a team of physicians to drive cost-effective, quality-focused care strategies that achieve targeted financial and clinical outcomes. This role ensures seamless communication with patients, care coordinators, social workers, and physicians, ensuring patients have the necessary support and resources in their communities while addressing any gaps in their care management. By monitoring patients throughout their care journey, the Transition Manager identifies trends that may impact cost and quality, contributing to the development of innovative plans to enhance patient outcomes and streamline care delivery.
Duties and Responsibilities:
Applies Case Management principles to the acute care in-patient population to ensure appropriate utilization of resources and level of care. This includes assessing, planning, implementing, coordinating, evaluating and collaborating with the interdisciplinary team, patients, families and community providers.
Assists in the facilitation of care management services for Integra ACO patients with Care Coordination who are identified for care management.
Assists in the facilitation of patient flow with Care Coordination by identifying barriers and working with the interdisciplinary care team to improve.
Assists in the identification of patients for Case Management and Social Service referrals during the review process.
Completes all documentation in a timely manner in Epic.
Serves as a resource for the Arches Medical Case Managers and functions as the liaison between the Integra care management team and the Arches Case Management team to facilitate their integration into Integra Community Care Network
Acts as a resource to the care management team.
Engage in process improvement activities that are focused on efficient care delivery and promotes positive clinical and quality outcomes including reducing unnecessary admissions, readmission rates and flow metrics.
Protects and preserves patient confidentiality at all times.
Performs related duties as required.
Requirements:
Bachelor’s degree in nursing or equivalent.
Minimum 5 years of related clinical acute care or case management experience
Valid RI Registered Nurse license required.
Case Management certification preferred.
Care New England Health System (CNE) and its member institutions—Butler Hospital, Women & Infants Hospital, Kent Hospital, VNA of Care New England, Integra, The Providence Center, and Care New England Medical Group, and our Wellness Center—are trusted organizations fueling the latest advances in medical research, attracting the nation’s top specialty-trained doctors, and honing renowned services and innovative programs to engage in the important discussions people need to have about their health.
Americans with Disability Act Statement: External and internal applicants, as well as position incumbents who become disabled must be able to perform the essential job-specific functions either unaided or with the assistance of a reasonable accommodation, to be determined by the organization on a case-by-case basis.
EEOC Statement: Care New England is an equal opportunity employer. All applicants will be considered for employment without attention to race, color, religion, sex, sexual orientation, gender identity, national origin, veteran or disability status
Ethics Statement: Employee conducts himself/herself consistent with the ethical standards of the organization including, but not limited to hospital policy, mission, vision, and values.
