Complex Care Managers are highly-skilled, licensed healthcare professionals responsible for maximizing the efficiency and effectiveness of health care interventions necessary for a patient to attain the optimal results from his or her plan of care. They are dedicated to patient and family centered care that values personal self-determination, enjoy managing multiple priorities at once, and engaging in creative, compassionate and ethical problem-solving. As a member of a multidisciplinary health care team, Care Managers perform comprehensive assessments and develop treatment plans that integrate the medical, social, and financial issues that impact individual patients, families, and populations.
Care Managers are responsible for working collaboratively with all healthcare team members to develop and implement treatment plans that support the patient-centered plan of care for both individual patients and the service-line. Care Managers act as consultants to the clinical team, service lines, and other departments regarding patient assessment and patient care and participate in program development and quality improvement initiatives.
In their role, Care Managers, by applying guidelines and collaborating with multidisciplinary teams, influence and direct the delivery and quality of patient care. Care Managers are assigned to a group of patients by medical specialty, unit, or clinic, and some activities may differ depending on the needs of the population.
Major responsibilities include:
- coordinating all facets of a patient's admission/discharge or outpatient visit/follow-up
- performing utilization review activities, including review of patient charts for timeliness of services as well as appropriate utilization of services
- ensuring optimum use of resources, service delivery, and compliance with external review agencies' requirements.
A health-system care management program has as its primary goal to ensure the most appropriate use of services by patients and, toward that end, to avoid duplication and misuse of medical services, control costs by reducing inefficient services, and improve the effectiveness of care delivery.
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