Registered Nurse - Case Manager - Hempstead New York

divh2RN, Case Manager/h2pWere building a world of health around every individual shaping a more connected, convenient and compassionate health experience. At CVS Health, youll be surrounded by passionate colleagues who care deeply, innovate with purpose, hold ourselves accountable and prioritize safety and quality in everything we do. Join us and be part of something bigger helping to simplify health care one person, one family and one community at a time./ppLocations:/ppFreeport: 14-16 Brooklyn Ave, Freeport, NY 11520/ppHempstead: 210 Fulton Ave, Hempstead, NY 11550/ppFar Rockaway: 10-48 Beach 20th St, Far Rockaway, NY 11691/pp*Subject to adjustment based on clinic needs/pp*Eligible candidates may receive a sign-on bonus as part of the offer package./ppRole Description: In partnership with the primary care provider, (PCP), the RN, Case Manager is the lead for care management activities, drives care coordination and collaborates with interdisciplinary teams to ensure care continuity for complex patients. This role focuses on preventing avoidable admissions, driving efficient resource utilization, and ensuring effective team-based care. It is a field-based, in-person/on-site role, requiring strong relationships between patients, providers and care team members./ppCore Responsibilities:/pulliManages an assigned caseload of complex patients in a value-based care environment, with a focus on driving reduced admissions, readmissions, and medical utilization./liliAccountable for panel metric performance in admission prevention, readmission prevention, and transitions of care metrics./liliOwns overall care coordination for assigned patients, functioning as the primary point of contact and ensuring alignment, accountability, and follow-through across the care team./liliManage transitions of care episodes for patients on their panel, including timely completion of structured clinical assessments to identify post-discharge needs, medication reconciliation on behalf of the PCP, and addressal of identified needs directly or via collaboration with other team members./liliCollaborates patients PCP, family/caregiver, Social Worker, Behavioral Health Specialists, and other care team members, as needed to evaluate the individuals needs, goals, and plan of action and ensure care plan progression./liliEnsure timely documentation of key clinical assessments after admissions, while balancing in-center care team planning meetings./liliLead in-person interdisciplinary care planning meetings to ensure effective care coordination and management between providers visits./liliPerform timely nursing assessments and provide patient education for chronic condition management and transitions of care./liliEducate patients and families, empowering them in their care, and advocating for their needs./liliDocument visits in electronic health record according to internal standards/liliOther duties as assigned./li/ulpWhat are we looking for?/pulliFluency in Spanish or other languages spoken by people in the communities we serve, strongly preferred/liliCurrent RN license in assigned state is required; Bachelor degree in nursing preferred./liliMinimum of 6-8 years nursing experience./liliCertified Case Manager (CCM) required, or willingness to obtain within 12 months of hire, unless candidate has 2-3 years of relevant care/case management experience/lili2+ years experience in transitional nursing, emergency room nursing, care coordination, discharge planning, or home health is strongly preferred./liliDemonstrated skill in motivational interviewing, patient activation, time management, and navigating community and social resources./liliA flexible and positive attitude/liliComfort with ambiguity and change/liliHigh emotional intelligence as evidenced by ability to evaluate/perceive a situation from multiple lenses and understand various perspectives in coming to problem resolution./liliAccess to reliable transportation and ability to travel throughout the communities OSH serves/liliUS work authorization/liliSomeone who embodies being Oaky/li/ulpWhat does being Oaky look like?/pulliRadiating positive energy/liliAssuming good intentions/liliCreating an unmatched patient experience/liliDriving clinical excellence/liliTaking ownership and delivering results/liliBeing relentlessly determined/li/ulpWhy Oak Street Health?/ppOak Street Health is on a mission to rebuild healthcare as it should be, providing personalized primary care for older adults on Medicare, with the goal of keeping patients healthy and living life to the fullest. Our innovative care model is centered right in our patient communities, and focused on the quality of care over volume of services. We are an organization on the move! With over 200+ locations and an ambitious growth trajectory, Oak Street Health is attracting and cultivating team members who embody Oaky values and passion for our mission./ppOak Street Health Benefits:/pulliMission-focused career impacting change and measurably improving health outcomes for Medicare patients/liliPaid vacation, sick time, and investment/retirement 401K match options/liliHealth insurance, vision, and dental benefits/liliOpportunities for leadership development and continuing education stipends/liliNew centers and flexible work environments/liliOpportunities for high levels of responsibility and rapid advancement/li/ulpOak Street Health is an equal opportunity employer. We embrace diversity and encourage all interested readers to apply./p/div