UW Medicine's mission is to improve the health of the public by advancing medical knowledge, providing outstanding primary and specialty care to the people of the region, and preparing tomorrow's physicians, scientists and other health professionals. UW Medicine owns or operates Harborview Medical Center, Northwest Hospital & Medical Center, Valley Medical Center, UW Medical Center, a network of UW Medicine Neighborhood Clinics that provide primary care, UW Physicians, UW School of Medicine, Airlift Northwest, and other owned, operated or affiliated entities as appropriate. In addition, UW Medicine shares in the ownership and governance of Children's University Medical Group and Seattle Cancer Care Alliance a partnership among UW Medicine, Fred Hutchinson Cancer Research, and Seattle Children's. UW Medicine Population Health Management is excited to be recruiting for newly-created, outstanding opportunities: Population Health Managers. These grant-funded positions will be full-time, 100% FTE and anticipated to be 12-14 months in duration with possible extension based on funding. The Population Health Manager (PM) is a newly-created and unique care manager position within the UW Medicine Population Health Management team. The role is a clinical position created to support UW Medicine's Care Management Program with particular focus on Transitional Care Management (TCM), Chronic Care Management (CCM), Annual Wellness Visits (AWV), and High Risk Care Management (HRCM). The Population Manager will serve as a liaison between the Population Management team and the primary care clinics in either a central or embedded clinic role with the intent to optimize TCM and CCM opportunities for our entire patient population that experience an inpatient admission post discharge. This PM role embedded in the clinic will support our primary care providers furnish TCM and AWVs under CMS "Incident to" guidelines. The primary responsibility of the Population Manager will be to coordinate post-inpatient discharge visit follow-up with a primary care provider (PCP). During the specified time period the interactive contact will assess the patient's or caregiver's understanding of discharge instructions, medication reconciliation, open care gaps, identify CCM needs, and ensure the PCP follow-up visit is scheduled. Population Managers embedded in clinics will provide the TCM or AWV under the supervision of a primary care provider. Transitional Care Management (TCM), Chronic Care Management (CCM), and High Risk Care Management (HRCM), including analyticsRelationship Management to Optimize Care ManagementQuality & ComplianceOther responsibilities to support the overall goals of the population gap management initiativeREQUIREMENTS:Bachelor's degree in Nursing and Licensed as Registered Nurse (RN) in Washington State. Four to five years of relevant clinical nursing experience, preferably in an ambulatory care setting, care management, case management, or clinical coordination. Skill set to telephonically assess a patient's health literacy and self-management of care. Skill set to effectively answer patients questions via phone and give appropriate guidance. Skill set to support care gap closure that can be done via the phone, which may include gathering information from patient that directs to where prior preventative screenings furnished so records can be requested Skill set to provide care management or to quickly learn that process.Skills to assess clinically patients needing additional support through chronic care management.Demonstrated ability to sort through data reports to identify targeted patients. Demonstrated flexibility in being deployed at one primary care clinic while serving several clinics; as well as receiving some supervision by primary care clinic leadership while being managed by central Population Health Management director.Demonstrated ability to work collaboratively primary care medical home team, as well as the population health care management team.Organized, goal-oriented, and determined to meet time targets or deadlines. Track record of being confident to speak up when any issues arise or problems have been identified. Comfortable learning new computer software programs.Demonstrated ability to efficiency facilitate the scheduling of provider appointments.Track record of appropriate telephone etiquette.Diligent with timely and clear documentation of activities.Enjoys and embraces challenges and achieving targeted goals.May need to use the provided language line when speaking with Non-English patients.An equivalent combination of education and experience may substitute for stated requirements.
Founded in 1861, the University of Washington is one of the oldest public institutions in the west coast and one of the preeminent research universities in the world. The University of Washington is a multi-campus university comprised of three different campuses: Seattle, Tacoma, and Bothell. The Seattle campus is made up of sixteen schools and colleges that serve students ranging from an undergraduate level to a doctoral level. The university is home to world-class libraries, arts, music, drama, and sports, as well as the highest quality medical care in Washington State and a world-class academic medical center. The teaching and research of the University’s many professional schools provide undergraduate and graduate students the education necessary toward achieving an excellence that will serve the state, the region, and the nation. As part of a large and diverse community, the University of Washington serves more students than any other institution in the Northwest.