Nurse Case Manager - Registered Nurse

About the role

We are seeking a Registered Nurse to serve patients throughout Aiken County. The Nurse Case Manager is a critical part of the patient’s care team, visiting patients in their homes, long-term care facilities, and other settings to evaluate needs and initiate telemedicine visits. The role requires daily travel within a designated service area and adherence to all applicable laws, regulations, and policies within the scope of practice.

Responsibilities

• Facilitate receiving all medical records from the patient’s primary provider and specialists.
• Review medical records.
• Complete consents with patients.
• Enroll patients in Care Management, if they meet eligibility criteria.
• Initiate a Care Management Plan of Care, if the patient is eligible.
• Capture all diagnoses at the highest specificity by creating gaps and ensure they are accepted.
• Complete Annual Wellness Visits (AWV’s) to be reviewed by the provider.
• Complete cognitive impairment screenings.
• Complete Social Determinants of Health (SDoH) assessments and/or screenings.
• Complete Advance Care Planning (ACP’s) to be reviewed with the patient by the provider.
• Evaluate for home health, hospice, palliative care, or consults with specialty divisions.
• Evaluate for Remote Patient Monitoring (RPM) devices, resources, or tools that may improve quality of life.
• Communicate and coordinate care among interdisciplinary teams, patients, and caregivers.
• Reconcile prescribed and over-the-counter medications, vitamins, supplements, herbal remedies, and other treatments.
• Provide post-discharge education.
• Evaluate for adaptive equipment and Durable Medical Equipment (DME).
• Evaluate for safe environment.
• Evaluate acute conditions or follow up from previous visits.
• Accurately document and log Care Management activities.
• Work with the care team to keep patient Care Management care plans up to date.

Qualifications

• Must be a licensed nurse; Registered Nurse preferred.
• License must be in good standing with the appropriate board/issuer.
• Minimum of three (3) years of clinical experience preferred.
• Experience in community settings preferred.
• Proven ability to effectively communicate and collaborate with interdisciplinary care teams, patients, and caregivers.
• Strong written and verbal communication skills.
• Basic computer knowledge.
• Ability to manage and demonstrate effective leadership skills.
• Demonstrated good interpersonal and communication skills under all conditions and circumstances.
• Ability to foster a cooperative work environment and manage multiple responsibilities with sound judgment.
• Must be able to work flexible hours and travel between offices, facilities, etc.
• Must be a licensed driver with an insured automobile in good working order.

Benefits

• Competitive Compensation Package with Bonus Opportunities
• Employer Matched 401(k)
• Free Visit & Prescriptive Services with HDHP Insurance Plan
• Employer Matched HSA
• Generous PTO Package
• Career Development & Growth Opportunities
• Vehicle allowance