RN Care Manager Case Management

Care Manager RN

Your passion belongs at UNC Health. Join more than 56,000 teammates working together to improve the health and well-being of the communities we serve across North Carolina.

The Care Manager RN plays a crucial role in providing comprehensive and coordinated care to patients within UNC Health. This position involves utilizing a variety of skills, including risk segmentation, patient assessments, patient-centered care plans, tasks or interventions, care transitions, delegated work, and payer communication. The Care Manager works collaboratively with healthcare providers, patients, and their families to ensure that patients receive the highest quality of care and support throughout their healthcare journey.

Responsibilities include:

• Patient Assessments: 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.
• Patient-Centered Care Plans: 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.
• Risk Segmentation: 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.
• Tasks or Interventions: 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.
• Care Transitions: 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.
• Coordinated Work: Coordinate care management tasks with other members of the healthcare team while maintaining accountability for the overall coordination and management of patients' care as applicable per patient population.
• Payer Communication: Collaborate with payers, insurance companies, and utilization management teams to optimize reimbursement and facilitate timely approvals for necessary care and services. Accurately document and bill for services rendered, as applicable, in compliance with insurance and regulatory requirements. Collaborate with billing and coding professionals, as applicable, to ensure compliance with coding and documentation requirements.
• Longitudinal Care as part of the Medical Home (varies per patient population and care setting): 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.

Education Requirements: Graduation from a state accredited school of professional nursing. Magnet hospitals: 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 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/and 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.