Nurse Care Manager

Responsibilities Identifies patients for proactive interventions using specific screening criteria, medical record review, payor models, medical risk scores, or referrals. Assesses patients' medical, functional, and social conditions per department policy/guidelines to develop individualized care plans and connect them with community resources. Develops, maintains, and monitors patient care plans consistent with NCQA and department policies/guidelines, ensuring adherence to medical plans and focusing on prevention measures. Supports patient self-management and behavior change using motivational interviewing and coaching techniques. Educates healthcare team members about case management processes, appropriate referrals, and advocate for patient rights. Collaborates with physicians and other healthcare team members on the patient’s behalf to ensure the patient receives quality and timely care and resolves any delays or issues. Develops and maintains collaborative partnerships with hospital care management, post-acute providers, and other care managers to ensure seamless transitions and continuity of care. Requirements Current Registered Nurse (RN) license in state of practice. Bachelor of Science in Nursing (BSN) from an accredited institution (degree verification required). RNs hired or promoted into this role must obtain their BSN within four (4) years of hire or promotion. Demonstrated clinical nursing experience in chronic disease management, and familiarity with chronic disease terminology and processes. Demonstrated understanding of disease management including treatment, length of stay, identifying barriers to delivery of care and any variation. Proficiency in basic computer skills and Microsoft Office software. Caregivers whose duties require them to conduct home or community visits must maintain current BLS certification, have a current driver’s license, current auto insurance, an acceptable driving record and reliable transportation. #J-18808-Ljbffr