Centralized Medical Services RN Care Manager Jacksonville Market

ArchWell Health is re-imagining the practice of primary care. We are putting the relationship between patient and physician at the center of a value-based model focused on outstanding patient experience improved access and better our medical clinics we provide comprehensive primary care for senior adults with traditional Medicare and Medicare Advantage plans focused on delivering improved quality better patient experience and lower total cost of Summary:The Nurse Care Manager is responsible for helping coordinate and evaluate the management of patients with acute and chronic conditions across the care continuum to achieve high quality care measured by positive patient outcomes. This position will work closely with members of the care team to follow the patient from our centers into acute and post-acute facilities as well as their home environments. The Nurse Care Manager plays a pivotal role in developing the care plan alongside the care team and then executing to achieve goals/objectives standards of performance regulatory compliance and quality patient a trusting relationship with patients their families and/or with clinical staff and other care team members to achieve patient goals. Reduce network costs by driving referrals to preferred groups and identifying excessive referral high-risk/complex physical functional social psychosocial environmental learning and financial needs and develop a comprehensive individualized care plan based upon identified needs. Perform case management following the nursing process and standards of practice established by the Case Management Society of America (CMSA). Provide patient education care coordination and other interventions needed to help patients a achieve their health Motivational Interviewing to build patient engagement. Evaluate progress toward patients goal telephonically with hospital case managers physical therapists (PT) social workers patients and families/caregivers to facilitate a safe discharge and plan for transitions of transitions of care assessment/screening medication reconciliation and care coordination following discharge to home. Required Skills/Abilities:Ability to plan implement and evaluate patient specific care with monitoring assessing recording and adjusting plan knowledge of patient medical knowledge of community-based organizations and social services support agencies/ interpersonal communication skills with exceptional active listening empathetic non-judgmental and in a collaborative team -starter critical thinker and ability to work independently in a remote and Experience:Associate degree in Nursing Degree in Nursing (BSN) or RN with bachelors degree in a related clinical field preferred.A valid active unrestricted Registered Nurse (RN) license in State of employment to obtain an RN license in other states with an ArchWell Health center (compact and non-compact locations).A minimum of 2 years clinical work experience required.A minimum of 1 year of utilization review home health discharge planning experience highly desired.A minimum of 1 year of case management experience in acute case management or ambulatory case management experience highly desiredCertified Case Manager certification is preferred. Certification through the Commission for Case Manager Certification (CCMC) or the American Association of Managed Care Nurses (CMCN) or willingness to obtain certification within a specified time. ICD-10 CPT codes HCPCS knowledge care experience including knowledge of HEDIS and CMS guidelines driven and motivated to join an organization that will transform the way we deliver accessible clinically excellent care to computer skills including Microsoft in Spanish or other languages spoken by people in the communities we serve (where necessary)Embodies and serves as a role model of ArchWell Healths Values:Be compassionateStrive for excellenceEarn trustShow respectStay resilientAlways do the right thingArchWell Health is an equal opportunity employer. Qualified applicants will receive consideration for employment without regard to their race color religion age sex sexual orientation gender identity national origin disability veteran status or any other protected classification.

Required Experience:

Manager