Registered Nurse Care Manager, Supervisor - PSH

About the role

The Supervisor, Registered Nurse Care Manager - Permanent Supportive Housing delivers patient-centered care coordination for individuals requiring specialized services. They collaborate with patients, caregivers, healthcare providers, educational systems, and interdisciplinary teams to ensure comprehensive, integrated, and compassionate care.

Responsibilities

• Delivers patient-centered care coordination for individuals requiring specialized services.
• Collaborates with PSH HCC partners, including Integral Care, Central Health, ECHO, and PSH site case managers on patient-centered care.
• Serves as a point of contact for patients enrolling in PSH HCC.
• Coordinates and oversees implementation of program goals, processes, schedules, and standards in collaboration with program managers.
• Supervises Care Management team members, including hiring, onboarding, competency/quality monitoring, evaluations, and performance management.
• Serves as a liaison to program managers to support data engagement, population health initiatives, and value-based care principles.
• Trains staff, assigns and monitors completion of tasks, and ensures all team members understand goals and expectations.
• Manages scheduling for Care Management staff; oversees timekeeping, time-off requests, and staffing levels.
• Oversees daily staff activities and provides support for day-to-day questions.
• Leads team huddles.
• Manages escalated patient issues using a Trauma-Informed Care approach and provides direction and follow-up to staff and care teams.
• Compiles data for departmental and program reporting.
• Reviews staff work for accuracy, evaluates performance, and provides coaching as needed.
• Implements corrective actions, including coaching, disciplinary steps, demotion, or termination when necessary.
• Participates in quality initiatives to ensure compliance with evidence-based guidelines and improve patient outcomes.
• Empowers patients and/or their families to be engaged and active participants in their care management.
• Performs thorough biopsychosocial assessments with patients and their families to identify care needs, strengths, and potential barriers to optimal health outcomes.
• Develops a comprehensive care plan in collaboration with patients, families, and the primary care team.
• Continuously monitors patients' biopsychosocial needs and provides timely follow-up in alignment with program protocols to ensure continuity of care and support.
• Coordinates transitions between sites and providers of care.
• Provides education and guidance to patients and their families to support understanding of health conditions, promote self-management, and enhance overall well-being.
• Coordinates and streamlines patient referrals to appropriate community-based services, ensuring timely access to resources that support health, wellness, and social needs.
• Delivers direct nursing care in alignment with program protocols, including executing standing delegation orders and administering medications and treatments in accordance with established standards of practice.
• Performs patient triage by assessing clinical and psychosocial needs to prioritize care and ensure timely intervention and appropriate resource allocation.
• Accurately completes all documentation related to direct and indirect patient care in a timely manner, ensuring that medical records are up-to-date, thorough, and compliant with organizational standards.
• Plays an active role in daily unit-based patient care huddles and periodic clinic-wide informational meetings, patient conferences, and planning sessions.
• Engages respectfully and collaboratively with patients and their families, utilizing a trauma-informed care approach to foster trust and build positive, supportive relationships.

Requirements

• Education: Associate's Degree - Graduation from an accredited school of nursing [Required]; Bachelor's Degree - Bachelor of Science in Nursing (BSN) [Preferred]
• Experience: Three (3) years of clinical nursing experience [Required]; Four (4) years of clinical nursing experience [Preferred]; One (1) year of experience providing Care/Case Management services [Preferred]; One (1) year of experience providing care to individuals experiencing homelessness [Preferred]; Lead/supervisor experience [Preferred]

Qualifications

• Licenses & Certifications: Active, unrestricted Registered Nurse License in the State of Texas or Compact State Licensure [Required]; Current Health Care Provider Cardiopulmonary Resuscitation (CPR) certification through American Heart Association or American Red Cross. Will be required to maintain a current CPR certification during employment [Required]; Valid Texas Driver's License [Required]