Role Description
The Care Management Nurse provides intervention for patients enrolled in the care management program; develops comprehensive plan of care for patient's individual needs that transition across the health care delivery system.
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Accurately gathers and interprets information to identify patients suitable for effective intensive care management intervention.
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Develops relationships with patients and uses assessment skills to identify physical, psycho-social, financial, and environmental health care needs.
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Assesses and identifies appropriate resource utilization, level of care, and treatment options to develop a comprehensive plan of care.
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Constructs care plans utilizing evidence-based care guidelines, preventive guidelines, protocols, and metrics in partnership with patients and clinical teams.
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Educates patients and ancillary personnel about health care needs, safety issues, and benefits, including patient education tools.
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Collaborates with clinical staff in the development and execution of plans of care and achievement of goals.
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Researches, secures, and links resources, services, and supports for patients and families.
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Coordinates care of patients, focusing on transitions of care across the healthcare delivery system.
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Utilizes electronic tools, such as EMR, to document assessments, clinical findings, needs, treatment plans, and progress toward goals.
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Actively participates in safety initiatives and risk mitigating measures, completing all safety-related competencies and requirements timely.
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Must perform the professional, clinical, and/or technical competencies of the assigned unit or department.
Qualifications
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High School Graduate
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Bachelor Degree in Nursing
Requirements
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Licensed Registered Nurse (LRN) - Multi-State - State Board of Nursing
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Must have current active multistate RN license in good standing in the state of residence OR active single state RN license in good standing in the state of work with proof of application for a multistate RN license.
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Staff hired prior to 2/1/2024 must obtain a multistate RN license by 3/31/2026 at the next RN license renewal.
Preferred Licensure and Certification
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Advanced Cardiac Life Support (ACLS) - American Heart Association (AHA)
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Basic Life Support Heartsaver (BLS HS) (Non-Clinical) - American Heart Association (AHA)
Knowledge Requirements
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Strong computer skills
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Efficiently enters information in EMR while interacting with patients telephonically or in person.
Company Description