Nurse Case Manager

About the Role

West Cecil Health Center is seeking a Nurse Case Manager to join their Medical Practice Team in Havre de Grace. This role focuses on care coordination for patients identified as high or potential high utilizers of the healthcare system, aiming to integrate services and improve continuity of care and outcomes. The Nurse Case Manager will lead Medicare Shared Savings Program efforts, promote preventative wellness services, and ensure effective care coordination across the continuum of care. Additionally, this position manages the SBIRT (Screening, Brief Intervention, and Referral to Treatment) program and care coordination for patients with addiction needs, while assisting providers with clinical tasks within the Maryland Board of Nursing scope and standards.

Responsibilities

• Coordinate and execute care plans for high-risk patients.
• Establish, maintain, and monitor outcomes of SBIRT, Chronic Care and Transition Care Management, and Medicare Shared Savings Programs.
• Monitor and action plan on clinical quality data, including SBIRT, UDS, HEDIS, and PCMH measures.
• Deliver direct-patient care and facilitate provider efficiency within the scope of nursing practice.
• Ensure compliance with internal policies, local, state, and federal laws and regulations.
• Establish and maintain collaborative relationships within the organization and with external stakeholders such as the Bureau of Primary Health Care, state agencies, community partners, and insurance carriers.
• Conduct comprehensive Medicare Annual Wellness Visits for eligible beneficiaries.
• Build therapeutic relationships with patients and determine risk levels for substance abuse, particularly opioid abuse.
• Offer educational support, referrals for treatment, and coordinate care for clients with substance abuse disorders.
• Support patient engagement in self-management for chronic diseases and substance abuse disorders.
• Analyze, synthesize, and communicate quality data accurately and objectively.
• Demonstrate problem-solving skills and critical decision-making based on data.
• Manage conflict, promote change, and inspire high performance standards.
• Travel locally and occasionally out-of-area to monitor quality performance and establish relationships with key resources.
• Use technology to collect, retain, analyze, and report critical information related to case management and quality outcomes.
• Communicate effectively in written, verbal, and presentation formats across all organizational levels.
• Perform other duties as assigned.

Requirements

• Current Maryland RN license required.
• Completion of a BSN required; Master’s Degree in Nursing preferred.
• Three (3) years of nursing care experience preferred.
• Experience with quality-based reimbursement models, utilization management, substance abuse, or outpatient medical practice preferred.
• BLS certification required.
• Demonstrated skills in clinical case management, comprehensive assessments, monitoring patient progress, critical thinking, and facilitating access to community resources.
• Ability to communicate and collaborate effectively with internal and external stakeholders.
• Ability to adapt to changing or crisis environments and make independent decisions consistent with policies and ethical standards.
• Strong prioritization, time management, and data analysis skills; proficiency in word processing, Excel, and data management.
• Normal accessibility and mobility throughout the region required.
• Prolonged sitting and working at a computer terminal; standing, bending, walking, and lifting up to 25 lbs.
• Occasional contact with bloodborne pathogens and hazardous waste; required to wear appropriate PPE.

Benefits

• Medical, Dental, and Vision insurance.
• Health Reimbursement Arrangement.
• Employer-paid Life, AD&D, and Disability insurance.
• 401K with employer match.
• Generous Paid Time Off and Volunteer time.
• Paid Holidays.
• Education reimbursement.
• Growth and advancement opportunities.
• Company-sponsored events and employee engagement committees.

Pay

$80,000 - $94,000 yearly salary.

Schedule

This is a full-time position. Days and hours of work will be scheduled in accordance with West Cecil Health Center’s operating hours.