RN Outpatient Care Manager - FT Mon. - Fri. 8am to 4:30pm - OMC Jeff Hwy

About the role

This job manages identified complex/catastrophic patients attributed to the organization and its Network of partner providers. Uses the case management process to assess the healthcare needs of the enrollee, identify barriers to care, develop a comprehensive treatment plan complete with specific goals and objectives, implement a treatment plan in collaboration with the PCP team and the other providers involved in the patients’ care, negotiate and coordinate service for the patient, monitor and evaluate the effectiveness of the plan in achieving the goals and objectives, and change and modify the plan as needs and situations change.

Responsibilities

• Collaborates with members of the health care team, the patient, and patient’s caregiver(s) to develop and implement a coordinated treatment plan across the continuum
• Affirms patient for social determinants of health that may create barriers to care and/or adversely impact the care and treatment plans. Includes SDOH in the care/treatment plan and refers to Social Work or Community Health Worker as appropriate and guided by workflow/process
• Utilizes the case management process to develop comprehensive cost-effective plans of care for patients in care management
• Collaborates with the multidisciplinary team, Primary Care Provider, and other appropriate care providers to facilitate appropriate care and treatment of the patient
• Coordinates referrals and appointments with members of the care team
• Provides in-depth disease-based patient education and formulates collaborative action plans with patient/caregiver to achieve agreed-upon goals for self-management and to improve patient health status
• Identifies quality issues that may adversely affect patient outcomes and submit to department leadership

Requirements

Education Required - Graduate of an accredited school of nursing. Work Experience Preferred - Bachelor’s degree in nursing. Required - 3 years of experience in a clinical setting; experience documenting in an electronic medical record and using Microsoft Office; experience working in a multi-disciplinary team environment. Preferred - Experience in case management, care coordination or disease management.

Qualifications

• Current Registered Nurse (RN) License in the state of practice.

Skills

• Proficiency in using computers, software, and web-based applications.
• Effective verbal and written communication skills and ability to present information clearly and professionally to varying levels of individuals.
• Excellent knowledge of managed care, CMS, Medicaid and other regulatory standards/requirements and ability to use community resources and other resources to facilitate the patient's care throughout the care continuum.
• Good organizational and time management skills and ability to be self-directed and demonstrate good judgement.

Benefits

Not specified.

Pay

Not specified.

Schedule

Not specified.