Chronic Disease Case Manager

Job Title: Chronic Disease Manager RN Job Type: Full-time (Monday-Friday, 8:00 AM - 5:00 PM) Travel: 0-15%

Qualifications:

• Associate’s degree in a related field required; Bachelor’s degree preferred
• Current RN/LPN license in the appropriate state required
• Minimum of 1 year of experience in a medical facility, with prior case management experience preferred
• Proficiency in Microsoft Word, Excel, and electronic record-keeping systems
• CPR and TB certification at the time of hire, renewed annually
• Valid driver’s license and reliable transportation

Job Summary:

Discover a rewarding career at Arcare. We are seeking a skilled, compassionate, and detail-oriented Chronic Disease Case Manager RN to join the Arcare team. The Chronic Disease Case Manager provides chronic disease education, and case management support to both primary care patients and clients/patients living with HIV. The position works with the Clinical Director of Coordinated Care, Director and Assistant Director of Remote Care Management, HIV Medical Director, and Positive Connections Program Coordinator, and is under the general supervision of the Chief Medical Officer and/or Primary Care Providers. The Chronic Disease Case Manager will enroll referred and participating patients in the Remote Care Services including Chronic Care Management and Remote Patient Monitoring. Services are provided via phone, telehealth, secure messaging, or in person. This mode of delivery may also apply to working with HIV + clients/patients for case management services and support. The nurse will ensure all required paperwork, screenings, and education remain current and are completed in a timely manner. The nurse will continue to provide frequent monitoring/evaluation, documentation, follow-up, and collaboration to patient’s care team. This position demands the ability to interact with Federal, State, and local agencies to maximize the resources and to achieve program development goals.

Key Responsibilities:

• Develop a Medical Services Plan for clients/patients receiving ongoing Chronic Disease Case Management within thirty (30) days of enrollment following the standards and MCM Assessment form(s) required by ADH.
• Review Medical Services Plan for all active MCM clients/patients based on their acuity level following the standards required by ADH.
• Participate in case conferencing with the client's/patient’s medical services provider at a minimum of every six (6) months or as required by acuity level in the standards of care.
• Facilitate client/patient transfer and inactivation in compliance with ADH policies.
• Document client/patient interacting in the progress notes, on required forms and in the CAREWare database.
• Provide referrals for medical evaluation and treatment.
• Manage case consultation with physicians, dentists, Registered Nurses, Advanced Practices Nurses, Physician Assistants and Service Access Specialist.
• Provide case management of HIV medication therapy to include education of client/patient concerning side effects, monitoring disease process to include lab values, monitoring client/patient adherence and tolerance of medications.
• Coordinate medical care and disease management activities.
• Provides education/in-services to nursing staff as appropriate.
• Provide education about HIV, its transmission, complications, risk education and harm education.
• Conduct adherence assessment and interventions to include counseling, education and referral, as appropriate.
• Provide nutritional assessment and interventions to include counseling, education, and referral, as appropriate.
• Provide interventions and education about a variety of issues, as appropriate to both client/patients assessed need for intervention and the MCM's trained skills. Interventions may include (but are not limited to): 1) Healthful living habits 2) Holistic approach to wellness 3) Safer sex practices 4) Partner notification and testing 5) Prevention of exposure to opportunistic pathogens 6) Teaching women to perform breast self-exam 7) Needed immunizations
• Staff Relations/Team Support: 1. Assists team members in the provision of Part B medical services to HIV infected/affected clients/patients. 2. Provides Education/In-Services to CARE PROGRAM clients/patients and staff as appropriate. 3. Performs other necessary duties as required by the Chief Clinical Officer to provide quality health care services.
• Performs other necessary duties as required by the Director of Remote Care Management and Positive Connections Program Coordinator to provide primary health care services/HIV services.
• Maintains current knowledge of immunization protocols as outlined by the Arkansas department of Health.
• Participate as needed with outreach events directed by the Community Health team.
• Participates in the center’s quality improvement activities and performs duties in accordance with applicable standards.
• Assists in special projects as directed by the Director of Remote Care Management/Positive Connections Program Coordinator.
• Provide patient-centered care that incorporates culturally and linguistically appropriate services.
• Educate patients about health maintenance activities, adoption of healthy behaviors, and support services available in the community.
• Communicate with patients and families about health care issues and the importance of developing self- management goals and healthy behaviors.
• Assist in coordinating seamless transitions of patient care across multiple care settings by using combined expertise of care team members.
• Employ active listening techniques during interactions with patients, families, and team members.
• Use health information systems efficiently to manage and improve care at the individual and system levels and ensure the delivery of timely and accurate information.
• Participate in care team huddles to prepare and coordinate patient care activities.
• Incorporate quality indicators for specific disease states and /or patient variables into patient care plans.
• Other duties as assigned.

Skills & Attributes

• Exceptional communication and relationship-building skills to connect with diverse populations
• Strong organizational and time-management abilities to manage multiple priorities
• Analytical thinking and problem-solving capabilities to address patient care challenges
• Ability to work both independently and collaboratively within a team
• Commitment to patient-centered care, cultural sensitivity, and continuous learning

About Arcare

Founded on the belief that healthcare is a right, not a privilege, Arcare exists to make comprehensive, high-quality care accessible to everyone, especially in rural and underserved communities. What began in the rural Arkansas delta has grown into a multi-state healthcare network, but our mission remains the same: Health for All. That mission drives everything we do, from accepting every patient, regardless of insurance status or ability to pay, to expanding access to care and improving health outcomes in the communities we serve.

We believe strong communities start with strong teams. We foster a supportive, collaborative environment where employees are valued, encouraged to grow, and empowered to make a meaningful impact through their work. We invest in our people by supporting professional development, encouraging leadership growth, and providing opportunities to build long-term careers within the organization. A healthy work-life balance and a predictable schedule are part of our workplace culture.

Whether caring for patients in the clinic, supporting operations behind the scenes, or serving communities through outreach and education, our teams are united by a shared purpose: delivering compassionate, accessible care that improves lives.

Arcare offers competitive pay and a strong company-paid benefits package for full-time employees, including:

· Work-life balance through a predictable schedule. Schedules are established early and rarely change, so employees enjoy a steady workweek rhythm.

· No routine nights or weekends for most positions. (Some clinical roles may have limited weekend coverage based on clinic needs.)

· Company-paid employee medical, dental, and vision insurance.

· Free care at any Arcare clinic for employees and covered family members enrolled in the Arcare health plan, starting the first day of your employment.

· Company-paid life insurance and long-term disability coverage.

· 96 hours of paid vacation time for full-time employees who work 40 hours per week. Accrual begins on the first day of employment.

· 96 hours of paid sick time for full-time employees who work 40 hours per week. Accrual begins on the first day of employment.

· Paid holidays, including one floating holiday and one birthday holiday to be used during the month of the employee’s birthday.

· 401(k) retirement plan with company matching up to 200% of the employee's contribution of up to 4% after one year of employment.

· Company-paid renewal of applicable licenses and certifications, subject to supervisor and HR approval based on the employee’s position and job duties.

· Possible Continuing Education reimbursement for current employees, subject to supervisor and HR approval based on the employee’s position and job duties.

Loan Repayment Opportunities

Many Arcare locations serve medically underserved communities. Eligible clinical team members may qualify for federal loan repayment programs through HRSA, including the National Health Service Corps Loan Repayment Program and the Nurse Corps Loan Repayment Program. Eligibility and award approval are determined by HRSA based on role, location, discipline, and program requirements.

Application Assistance:

If you need assistance with the application process, please email humanresources@arcare.net.

Equal Opportunity Employer:

Arcare is committed to creating a diverse environment and is proud to be an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, veteran status, or any other characteristic protected by law.

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