CARE MANAGER-RN

Clinical Excellence

FT/ 80 hours per pay

Summary of Position

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.

Nature and Scope

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.