RN Care Manager (Per Diem)

Responsibilities

• Conduct comprehensive care manager assessments utilizing standardized assessment tools and nursing knowledge to evaluate patients' functional abilities, cognitive status, and psychosocial support systems. Identify any barriers to care and develop appropriate interventions to address them.
• Collaborate with providers, patients, their families, and the healthcare team on individualized care plans that align with patients' goals, preferences, and values. Ensure that care plans are evidence-based, culturally sensitive, and promote patient engagement and self-management.
• Utilize standardized tools and clinical judgment to identify and assess the risk level of patients based on various factors such as medical conditions, social determinants of health, and behavioral health needs. Develop strategies to effectively manage and mitigate risks for patients, ensuring their overall well-being and optimal health outcomes.
• Coordinate and facilitate necessary tasks or interventions to support patients' care plans. Collaborate with healthcare providers, community resources, and support services to ensure seamless coordination of care.
• Advocate for patients' needs and rights, ensuring that they receive appropriate and timely interventions.
• Participate in quality improvement initiatives to ensure patient, departmental, and organizational goals/outcomes are met or exceeded.
• Coordinate and facilitate care across various healthcare settings, ensuring seamless transitions and continuity of care. Communicate and collaborate with healthcare providers, specialists, and community resources to ensure comprehensive and coordinated care delivery.
• Facilitate multidisciplinary care team meetings to discuss patients' care plans and progress.
• Act as a key point of contact and advocate for patients within the care team. Provide ongoing support and care coordination throughout the patient's healthcare journey, ensuring continuity and comprehensiveness of care.

Requirements

• Graduation from a state accredited school of professional nursing
• Registered Nurse with a valid license to practice in North Carolina
• Minimum of 2 years of experience as a registered nurse

Qualifications

• 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