RN - Ambulatory

About the role

The Nurse Case Manager under the direction of the practice physician and/or advanced practice provider (APP) and the supervision of the Nurse Supervisor (RN), provides direct patient care, patient triage (in-person and telephonic), assessment, planning, directing and evaluating of a patient’s specific care plan and clinic visit.

Responsibilities

• Able to work effectively within a team of multi-specialty professionals.
• Facilitates the interdisciplinary team to plan, coordinate, implement and evaluate patient care for assigned service line across the continuum of care.
• Works proactively with the Quality Improvement Teams, patient care standards, and utilization management to coordinate the appropriate use of resources to achieve maximum clinical and financial outcomes.
• Participates in maintaining quality care and performance improvement through leadership, problem solving, decision making, and outcome measurement.
• Functions as a resource for the health care team, community, patient/family and payers by functioning as a clinician, consultant, advocate and educator for assigned service.
• Adheres to AMC’s regulatory agency (The Joint Commission) and internal compliance policies.
• Proactively monitors patients' clinical process through /patient care standards and evidence-based guidelines to ensure timely, appropriate interventions that achieve optimal patient outcomes.
• Collaborates with the health care team and appropriate department in the management of care across the continuum of care.
• Utilizes own special body of knowledge and evidence-based guidelines to provide leadership and guidance to the health care team in formulating an individualized multidisciplinary plan of care.
• Facilitates and participates in health care team care conference for patients with complex problems.
• Facilitates patient and family education to promote continuity of care and optimal patient outcomes.
• Demonstrates experience in the referral process and use of community resources.
• Contacts payer source to confirm/negotiate benefits and provide concurrent reviews.
• Identifies high-risk patients based on clinical and financial criteria for collaboration with patient financial services to problem-solve available resources.
• Ensures that appropriate medical/legal documentation is contained in patient's records.
• Assesses educational needs and provides learning opportunities for health care professionals relevant to particular cases and selected patient care groups.
• Collaborates with case management leadership to compile and report aggregate variances and data for specific patient care services.
• Communicates and analyzes aggregate variances with members of the health care team and develops strategies for variance reduction.

Requirements

• Registered nurse with a current license.
• Bachelor's degree preferred.
• Current CPR certification required.
• Minimum of three years clinical experience in an assigned service.
• Excellent customer service and communication skills.
• Ability to effectively present information and respond to questions from physicians, patients and their family members or other employees within the work setting.
• Recent experience in case management, utilization management and/or discharge planning/home care in a high volume, acute care hospital preferred.
• PRI and Case Management certification preferred.
• Demonstrates effective communication, facilitation, and organizational skills.
• Assertive and creative in problem solving, critical thinking skills, systems planning and patient care management.
• Self-directed with the ability to adapt in a changing environment.
• Basic knowledge of computer systems with skills applicable to utilization review process.
• Experience with Epic preferred.

Qualifications

• Minimum qualifications: Registered nurse with a current license.

Skills

• Effective communication and facilitation skills.
• Problem-solving and critical thinking skills.
• Systems planning and patient care management.
• Self-directed with the ability to adapt in a changing environment.
• Basic knowledge of computer systems with skills applicable to utilization review process.

Benefits

Not specified.

Pay

$83,200.00 - $128,960.00

Schedule

Day