Chronic Care Management RN

At Ovation Healthcare (formerly QHR Health), we’ve been making local healthcare better for more than 40 years. Our mission is to strengthen independent community healthcare by providing independent hospitals and health systems with the support, guidance, and tech-enabled shared services needed to remain strong and viable. With a strong sense of purpose and commitment to operating excellence, we help rural healthcare providers fulfill their missions.

About the role

The Chronic Care Management Registered Nurse provides outreach communication with patients and families enrolled in our Chronic Care Management Program by assessing chronic conditions, reconciling medications, and reviewing and updating care plans under the direction of the physician and coordination with the care teams to help the patient meet their goals. Compliance with rules and regulations of all applicable federal, state, and local laws, as well as ruralMED policies, is a condition of employment.

Responsibilities

• Assesses data regarding the patient’s physical, psychological, social, and spiritual dimensions based on the patient’s age and development.
• Reports and documents all observed symptoms, reactions, and changes in the patients’ condition to the Physician, APC, and/or Registered Nurse as appropriate.
• Assesses and enrolls patients in the CCM program.
• Creates nursing interventions as needed/required to help patients meet goals outlined in the provider’s care plan.
• Communicates with staff nurses, providers, and program managers to address any and all issues with patients enrolled in the CCM program.
• Reviews assigned patients on a monthly basis.
• Documents in the EMR to ensure compliance with the CCM program.
• Assists in the development, implementation, revision, and evaluation of a formal plan of care for patients enrolled in our program.
• Provides assistance to the Operating Practitioner and assists in the nursing process to direct and deliver patient care.
• Creates and maintains a comfortable and safe environment for patients, visitors, and other employees.
• Organizes and prioritizes daily assignments to provide optimal patient care and increase productivity.
• Conforms and complies with ruralMED Management Resources Codes of Conduct and with procedures, regulations, and rules in maintaining medical records.
• Maintains patient and employee confidentiality at all times.
• Demonstrates competency annually in assigned areas of work.
• Performs other duties as assigned or needed.

Requirements

• Degree or diploma from an accredited school of Practical Nursing.
• Currently licensed as a Registered Nurse (RN).
• Current BLS/CPR certification.

Physical Demands

The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

• Regularly required to use hands to finger, handle, or feel objects, tools, or controls; reach with hands and arms; and talk and hear.
• Regularly required to sit, stand, kneel, and walk, including walking up several steps.
• Occasionally required to reach with hands and arms, stoop, kneel, crouch or crawl, climb or balance, and taste or smell.
• Must regularly lift and/or move up to 20 pounds and occasionally lift and/or move up to 40 pounds.
• Specific vision abilities required include close vision, distance vision, color vision, peripheral vision, depth perception, and ability to adjust focus.

Work Environment

The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

• The noise level in the work environment is usually moderate.