RN Care Manager

About the role

Responsible for coordinating medical treatment, including administering assessments, developing care plans, and monitoring medication compliance. Develops relationships with patients to facilitate ongoing care management compliance. Connects patients with social and community support systems for continuation of care. Responsible for analytical and QM/RM support for initiatives and projects including but not limited to data facilitation/problem solving and coordinating the implementation of processes to ensure regulatory compliance. Aids departments and senior management in a professional and timely fashion. Assists the clinic in improving care management processes by providing consultative services that assure a proactive versus reactive approach. Provides oversight of the care management model. Analyzes social determinants of health for populations served. Monitors and leads improvement activities to connect patient resources with patient needs. Leads initiatives to build health equity for populations served. Coordination of external referral sources. Ensures appropriate utilization of healthcare resources to maintain PCMH certification. Assists with conducting and monitoring annual wellness visits (AWV). Creates a pathway for capturing relevant patient conditions to obtain accurate risk scores for individual care planning. Develop, identify, and analyze data and information for organizationalwide CM initiatives. Identifies EHR efficiencies to improve documentation of chronic care management and promote interoperability. Collaborates with the chronic care management program to improve preventive screening rates. Assists providers in meeting quality and efficiency outcomes through coordination of care. Utilizes data to improve efficiency. Coordinates with medical providers and Doctor's Alliance to monitor home health certifications and recertifications for compliance. Support the activities of teams including but not limited to Quality, Infection Control, Pharmacy, Environment of Care, Emergency Preparedness and Specialty ADHOC Committees. Provide and coordinate care management related education for clinic and medical staff.

Responsibilities

• Administers assessments and develops care plans
• Makes connections with patients for ongoing care management
• Supports the implementation of regulatory compliance processes
• Aids departments and senior management in professional matters
• Improves care management processes through consultative services
• Monitors and leads improvement activities for patient resource connection
• Develops initiatives to build health equity for populations served
• Carefully coordinates external referral sources
• Ensures appropriate utilization of healthcare resources to maintain PCMH certification
• Assists with conducting and monitoring annual wellness visits
• Creates pathways for capturing relevant patient conditions
• Analyzes data and information for organizational-wide CM initiatives
• Identifies EHR efficiencies to improve documentation and interoperability
• Collaborates with the chronic care management program to improve preventive screening rates
• Aids providers in meeting quality and efficiency outcomes through coordination of care
• Utilizes data to improve efficiency
• Coordinates with medical providers and Doctor's Alliance to monitor home health certifications and recertifications
• Supports the activities of various committees and teams
• Provides and coordinates care management related education

Requirements

• Licensure/Certification/Registration: Current licensure as a Registered Nurse in the State of Oklahoma
• Education: BSN or higher preferred. Nursing Case Management Certification (CMGT BC) OR related field with a minimum of 5 years of related experience required
• Experience: Minimum of three (3) years of bedside nursing experience. Experience in care management or population health management preferred
• Proven record of achievements and leadership, problem solving, and effective communication skills required

Qualifications

• Proven track record of success and leadership
• Strong problem-solving abilities
• Effective communication skills

Skills

• Data analysis
• Problem-solving
• Collaboration
• Communication
• Leadership

Benefits

N/A

Pay

N/A

Schedule

N/A