RN Care Manager

About the role

Become part of an inclusive organization with over 40,000 teammates whose mission is to improve the health and well-being of the unique communities served. This position supports two primary care clinics, one in Chapel Hill and the other in Mebane.

Responsibilities

• Patient Assessments: Conduct comprehensive care manager assessments using standardized tools and nursing knowledge to evaluate patients’ functional abilities, cognitive status, and psychosocial support systems; identify barriers to care and develop appropriate interventions.
• Patient-Centered Care Plans: Collaborate with providers, patients, families, and the healthcare team to create individualized care plans aligned with patients’ goals, preferences, and values; ensure evidence-based, culturally sensitive plans that promote engagement and self-management.
• Risk Segmentation: Use standardized tools and clinical judgment to assess patient risk based on medical conditions, social determinants of health, and behavioral health needs; develop strategies to manage and mitigate risks for optimal health outcomes.
• Tasks or Interventions:
  • Coordinate and facilitate necessary tasks or interventions to support care plans.
  • Collaborate with providers, community resources, and support services for seamless care coordination.
  • Advocate for patients’ needs and rights to ensure timely and appropriate interventions.
  • Participate in quality improvement initiatives to meet or exceed patient, departmental, and organizational goals.
• Care Transitions:
  • Coordinate and facilitate care across healthcare settings to ensure seamless transitions and continuity.
  • Communicate and collaborate with providers, specialists, and community resources for comprehensive care delivery.
  • Facilitate multidisciplinary care team meetings to discuss care plans and progress.
• Coordinated Work: Coordinate care management tasks with the healthcare team while maintaining accountability for overall patient care coordination.
• Payer Communication:
  • Collaborate with payers, insurance companies, and utilization management teams to optimize reimbursement and facilitate timely approvals.
  • Document and bill services in compliance with insurance and regulatory requirements.
  • Work with billing and coding professionals to ensure compliance with coding and documentation standards.
• Longitudinal Care as part of the Medical Home: Serve as a key point of contact and advocate for patients within the care team, providing ongoing support and coordination throughout the patient’s healthcare journey.

Education Requirements

• Graduation from a state-accredited school of professional nursing.
• Magnet hospitals requirement: BSN required or must be enrolled in an accredited program within 4 years of employment and obtain a bachelor’s degree with a major in nursing or a master’s degree with a major in nursing within 7 years of the employment date.

Licensure/Certification Requirements

• Registered Nurse with a valid license to practice in North Carolina.

Professional Experience Requirements

• Minimum of 2 years of experience as a registered nurse.

Knowledge/Skills/Abilities Requirements

• Strong knowledge of risk segmentation, patient assessments, patient-centered care planning, care transitions, and payer communication.
• Excellent communication, collaboration, and problem-solving skills.
• Ability to work independently and as part of a multidisciplinary team.
• Proficiency in electronic health records (EHR) and other relevant software applications.

Job Details

• Legal Employer: NCHEALTH
• Entity: Health Alliance
• Organization Unit: Pop Health Care Management
• Work Type: Full Time
• Standard Hours Per Week: 40.00
• Pay offers: Determined by experience and internal equity
• Work Assignment Type: Onsite
• Work Schedule: Day Job
• Location of Job: US:NC:Chapel Hill
• Exempt From Overtime: Yes