The Ambulatory Care Manager is responsible for facilitating and coordinating the care delivered to an assigned group of patients through multidisciplinary, multi-agency, and patient/family collaboration to ensure the delivery of cost effective quality care outcomes within various ambulatory care settings. This position focuses on Outpatient area, cardiac and surgery with some coverage responsibility for Emergency Trauma Center. Care management goals include patient advocacy; facilitate quality care and desired outcomes for patients; promote utilization of most appropriate level of care; obtain financial certification; decrease inappropriate clinical resource usage; promote early, timely discharge and provide smooth transition along continuum of care. Coordination involves assessment, planning, support, and evaluation of patient care and related outcomes. Activities to be performed include but are not limited to: utilization management, insurance verification, pre-certification with payors, clinical care management, clinical resource management, clinical teaching, and discharge planning. The Ambulatory Care Manager provides professional nursing care within Borgess Medical Center. The practice of professional nursing is the systematic application of specialized knowledge and skill, derived from the biological, physical, and behavioral sciences to the care, treatment, counsel and health teaching of individuals who are experiencing changes in normal health processes or who require assistance in the maintenance of health and the prevention or management of illness, injury or disability and demonstrates this through the application of the Standards of Clinical Nursing Practice and Standards of Professional Performance defined by the American Nurses Association. The Ambulatory Care Manager recognizes that each patient is an unique individual and has the right to quality nursing care that ensures mutual goal setting between the Ambulatory Care Manager and the patient and that the Ambulatory Care Manager assures patient rights and privacy are protected. Recognizing personal, interpersonal, and social systems, the nursing process facilitates the promotion, maintenance and restoration of an individuals health, incorporating knowledge of growth and development through the life span. The Ambulatory Care Manager is held accountable to the ethical and professional standards as defined in the ANA Code for Nurses, the ANA Nursings Social Policy Statement, the State of Michigan Public Health Code, and the ANA and Specialty Nursing Standards of Clinical Practice. The Ambulatory Care Manager is held accountable to the standards set by BMC as defined in the Administrative, Patient Care and Biosafety Policy and Procedure Manuals. The Ambulatory Care Manager is also accountable to adhering to the standards set by regulatory agencies such as but not limited to the Joint Commission on Accreditation of Healthcare Organizations (JCAHO), Conditions of Participation of Healthcare Finance Administration (HCFA), Michigan Occupational Health and Safety (MOSHA) and Emergency Medical Treatment and Active Labor Act (EMTALA). These accountabilities require individual competence in nursing practice, and the recognition and responsible acceptance of individual actions and judgments. Requirements:Bachelors degree in a health related field and 5 years recent experience/certification in utilization management, case management or focused discharge planning preferred. BSN or MSN or completion of BSN within 1 year of date of hire and one year experience certification in utilization management, case management or focused discharge planning preferred. Must be currently licensed as a registered nurse in the State of Michigan. Minimum of two years clinical experience in any setting. Prefer one year experience in an ambulatory care center specialty (acute healthcare environment) to assure sufficient understanding of patient types and to serve as expert resources to care teams. Other Requirements: Evaluation demonstrates past excellence in nursing practice and accountability in resolving patient care and system issues. Current knowledge and experience working with the following (for example): Community resources and services; placement options. Appropriate level of care (home care, rehab, and sub acute care, extended care facility). Rules and regulations of third party reimbursement for post hospital care/equipment. Current knowledge and experience working with third party payers regarding the following (for example): Appropriate criteria for hospitalization of patients. Pre-certification requirements. Requirements by payers for special review types. Basic computer skills in word processing and spreadsheet software preferred. Demonstrates leadership ability, communication, and interpersonal skills necessary to interact effectively with physicians, team members, external agencies/customers and patients/families. Analytical skills necessary to collect, tabulate, and analyze data to determine and implement effective actions and solutions. Work assigned/rotated shifts on weekends and holidays.