Care Management Outcome Specialist

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Under general supervision, the Outcome Specialist in Care Management performs professional work in the coordination, evaluation, and improvement of patient care outcomes. The Outcome Specialist develops and leads staff training programs to enhance the competency and performance of evidence-based practice for the case managers and other clinical staff. This role collaborates with interdisciplinary teams, facilitates discharge planning, and ensures compliance with quality standards and regulatory requirements. This role is crucial in driving performance improvement within the hospital's case management department, ensuring that patients receive timely, efficient, and high-quality care across the continuum. The Outcome Specialist's contribution directly impacts patient safety, satisfaction, and organizational success.

Essential Responsibilities

Responsibilities listed in this section are core to the position. Inability to perform these responsibilities with or without an accommodation may result in disqualification from the position.

• Planning, Implementation, and Evaluation of Care Coordination Programs: Responsible for organizing and executing comprehensive patient care programs that improve health outcomes, focusing on both short- and long-term goals.

• Quality and Outcome Improvement Initiatives: Coordinates and facilitates ongoing quality improvement projects and assesses the effectiveness of case management activities to ensure high standards of care. Analyzes patient data to identify trends and implement solutions for optimal patient outcomes.

• Staff Development & Training: Develops, coordinates, and evaluates staff development and training initiatives, ensuring all personnel are proficient in evidence-based care practices and competent in, patient care skills. Conducts competency verification, particularly in areas related to case management and patient discharge planning.

• Patient Discharge and Continuum of Care Planning: Works with the interdisciplinary team to coordinate safe and efficient discharge plans for patients, ensuring smooth transitions across care settings. Provides guidance and oversight in the development of care plans that consider cultural, age-appropriate, and individual patient needs.

• Outcome Evaluation & Data Analysis: Utilizes clinical data and outcome metrics to evaluate the effectiveness of hospital case management programs. Develops criteria to assess patient care outcomes, documenting program success and areas for improvement.

• Collaboration and Interdisciplinary Team Engagement: Serves as a liaison between nursing, medical staff, social work, and other departments to ensure seamless patient transitions and adherence to quality care standards.

• Compliance and Regulatory Oversight: Ensures that hospital care programs meet Joint Commission, CMS, and other regulatory standards. Maintains up-to-date knowledge of applicable healthcare policies and works to integrate them into hospital care processes.

• Preceptor Program: Plans, implements, and evaluates the hospital's Preceptor Program, fostering the professional development of new staff members and ensuring ongoing support and mentorship for nursing staff.

General Responsibilities

• Performs other duties as assigned.

Minimum Qualifications

Education Requirements

• If applying as a Registered Nurse: Bachelor of Science in Nursing (BSN) required.

• If applying as a Social Worker: Graduate of an accredited school of social work. License Master Social Worker (LMSW) under supervision or Licensed Clinical Social Worker (LCSW) required.

Experience Requirements

• At least 5 years of Care Management experience, 1 in an acute or ambulatory care setting.

License/Certification/Registration Requirements

• If applying as a Registered Nurse: Current Registered Nurse License (RN License issued by the Oklahoma State Board of Nursing, or a current multistate compact Registered Nurse (eNLC)).

• If applying as a Social Worker: Current Licensed Master Social Worker (LMSW) or under supervision for Licensed Clinical Social Work (LCSW) or LCSW from the Oklahoma State Board of Licensed Social Workers.

• Certification in Case Management (CCM) or Certified Professional in Healthcare Quality (CPHQ) highly preferred.

• Basic Life Support from the American Heart Association required

Knowledge/Skills/Abilities Required

• Professional demeanor. Self-directed. Ability to work as a member of a team.

• Excellent verbal and written communication (including documentation) skills.

• Detailed - oriented with excellent organizational skills.

• Commitment to fostering a culture of continuous learning, quality improvement, and patient-centered care.

• Strong assessment, critical thinking, and problem-solving skills

• Strong knowledge of healthcare regulations, including CMS guideline

• Show clear understanding of utilization management principles and integrate these with care management responsibilities.

• Serve as liaison between patients, families, and healthcare providers.

• Excellent organizational and project management abilities.

• Knowledge and skill in chronic disease management

• Strong organizational and time-management

• Ability to assess, adapt, and calmly respond to changing and crisis environment.

• Ability to facilitate patient access to community resources.

• Proficiency in utilizing electronic health records (EHR) and care management software.

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