Clinic RN Case Manager

Essential Functions, Duties and Responsibilities

• Patient Care Coordination: Assess, plan, implement, and evaluate individualized care plans for patients. Coordinate care across different services and providers, ensuring seamless patient transitions between inpatient, outpatient, and home care. Facilitate communication between patients, families, and healthcare providers to ensure understanding and adherence to care plans.
• Chronic Disease Management: Conduct thorough assessments of patients with chronic health conditions, including medical history, current symptoms, medication management, and psychosocial factors. Develop individualized care plans in collaboration with patients, caregivers, and healthcare providers, outlining goals, interventions, and timelines for managing chronic conditions effectively. Educate patients and their families about disease management, medication adherence, and lifestyle modifications.
• Resource Management: Connect patients with community resources and support services to enhance their quality of life and care. Assist patients in accessing financial assistance programs, transportation, and other necessary services.
• Education and Support: Provide health education and counseling to patients and their families on preventive care, self-care strategies, and healthy lifestyle choices. Support patients in understanding their diagnoses, treatment options, and the implications of their health conditions.
• Quality Improvement: Participate in quality improvement initiatives aimed at enhancing patient care and clinic operations.
• Documentation and Compliance: Maintain accurate and timely documentation in patients' medical records. Ensure compliance with clinic policies, state and federal regulations, and best practice standards.
• Multidisciplinary Collaboration: Work closely with physicians, nurses, social workers, and other healthcare professionals to deliver comprehensive care.

Qualifications

• Bachelor of Science in Nursing (BSN) required; Master of Science in Nursing (MSN) preferred
• Current Registered Nurse (RN) license in the state
• Current CPR certification