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OUTPATIENT CARE MANAGER St. Luke's Hospital - Chesterfield, MO

Company: St. Luke's Hospital
Location: Chesterfield
Posted on: January 7, 2022

Job Description:


The RN Outpatient Care Manager responsibilities include transitioning patients through the care continuum, medication management, coordinating communication between multiple providers, developing patient specific care plans, assisting patients with goal setting and lifestyle modification efforts, and evaluate patient progress toward goals. The Care Coordination Department institutes measures to address high-risk complex patients, improve transitions of care, improve patient outcomes, and reduce hospital readmissions. This position is integral to St. Luke's efforts to design, develop, and implement successful care delivery methodologies needed for patient care coordination across the healthcare continuum, alternative payment models and value-based care. The RN Outpatient Care Manager will work in active partnership with physicians, office staff, administration and other health care providers to develop and implement a well-coordinated plan of care to address patient needs across the continuum and ensure St. Luke's successfully meets quality performance and optimizes resource utilization.

Principle Accountabilities: % of Time Spent

1. Outpatient Care Manager Duties: 70%

Responsible for coordinating care of high-risk patients after discharge from the hospital

Review discharge instructions, perform medication reconciliation, schedule follow-up appointments and testing

Develop patient specific care plan, assist patient with goal setting, lifestyle modification, monitor progress, and mitigate barriers

Coordinate communication between providers, agencies and community services

Includes limited on-call responsibilities

Communicates vertically and laterally to other departments as needed and keeps leadership informed of any issues

Promotes a culture of two-way communication that informs, engages, and creates opportunities for staff, physicians and post-acute provider collaborative participation

2. Continuing Education: 25%

Is knowledgeable of hospital and community resources and ensures that appropriate resources and services are provided in the most appropriate setting or level of care.

Develops and maintains professional relationships with St. Luke's Medical Group physicians, and post-acute care providers.

Maintains knowledge base on industry updates, community resources, and chronic high risk conditions relevant to role. Applies knowledge to current practice role of RN Outpatient Care Manager.

3. Perform other duties as assigned. 5%

Total 100%


Current licensure as a Registered Nurse in the state of Missouri Required.

BSN required.

Three years clinical experience required. Experience managing CHF, COPD, AMI, and Pneumonia ideal.

Care management experience preferred.

Capable of utilizing computer hardware and software for the generation of reports.

Must be able to work independently and in coordination with various other persons and professions.

Has knowledge of physician practice operations, hospital operations, personnel roles, and community resources.

Must have excellent customer relations, communications, and organizational skills.

Working Conditions:

Employee is required to sit continuously and walk frequently. Employee must lift/carry a light (1-20 lbs.) medium (21-50 lbs.) and heavy (50 lbs. +) load occasionally. Employee may be required to lift over 100 lbs. with assistance. Employee is frequently required to bend, squat, crawl, kneel, climb, lift waist to overhead. Employee is occasionally required to reach forward and reach overhead. Employee may be required to do simple grasping and pushing/pulling.

(Occasionally: 1-33%, Frequently: 34-66%, Continuously: 67-100%)

The most significant of duties are included but this does not exclude occasional work assignments not mentioned or developmental duties.

Job Relationships: Interacts regularly with patients, physicians, families and other internal and external health care providers and insurance company representatives.

Supervised by: RN Supervisor, Care Coordination

Provides direction to: N/A

Takes direction from: RN Supervisor, Care Coordination



Faithful to our Episcopal-Presbyterian heritage and its ministry of healing, St. Luke's is dedicated to improving the health of the communities we serve.

Using talents and resources responsibly, we provide high quality, safe care with compassion, professional excellence and respect for each other and those we serve.


As an independent healthcare network, we create healthy communities in the region through our commitment to high quality, safe and personalized services.


Human Dignity

We accept and treat all persons as being created in the image of God.


We respond with caring to the needs of others as if they were members of our family.


We honor each person's rights and responsibilities in light of the common good.


We set and strive to attain high standards of performance and continuous improvement.


We use our talents and resources wisely, with honesty and integrity.

FACES - Friendly - Available - Caring - Efficient - Safe Communication Standards: Promotes and provides courteous and effective communication with internal and external customers.

Keywords: St. Luke's Hospital, Chesterfield , OUTPATIENT CARE MANAGER St. Luke's Hospital - Chesterfield, MO, Healthcare , Chesterfield, Missouri

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