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Clinical Excellence
FT/ 80 hours per pay
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Summary of Position
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The RN Care Manager will provide a systematic organization of care with the Physician Practice and will coordinate with other care team members and/or settings. The RN Care Manager will provide high quality, patient centered care management to patients identified as needed by high-risk registries. This will include, but is not limited to developing individualized care plans, care coordination across the continuum, prevention plans, and ongoing monitoring. The RN Care Manager will take a lead role in assuring the care team is informed of the overall care plan, progress and needs.
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Nature and Scope
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Care Management results from a complex exercise of clinical judgement, occurs through a relationship-based engagement with the care team, and addresses the patient’s identified health care goals. Essential functions include:
- Documentation of a mutually agreed upon plan of care based on patient’s goals, addressing all significant ongoing health problems and risks.
- Provide ongoing assessment, monitoring, and tracking in E H R. Care will be managed by the use of a registry functionality with interventions triggered by regular review and monitoring.
- Provide proactive care and education outside the routine office visit, for example by phone, Patient Portal, or other access activities.
- Build a trusting, professional relationship with the patient, family, and/or caregivers.
- Utilize self-management and shared decision-making tools.
Qualifications
- BSN required.
- Maintain current RN licensure as issued by the State of Ohio Board of Nursing.
- A minimum of three years’ previous nursing experience required; leadership role preferred.
- Solid knowledge of chronic conditions, strong assessment, and patient interview skills.
- Demonstrate accurate and timely data and computer skills.
- Excellent written and verbal communication skills.
- Must be self-directed with the ability to work independently.
- Ability to prioritize projects, and multi-task as appropriate.
- EPIC knowledge preferred.
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