Job description

The RN Care Manager will focus on achieving patient wellness and autonomy through advocacy, communication, education, identification of service resources and service facilitation. Overall, they will promote direct communication with the patient and appropriate services & personnel to optimize health outcomes.

Primary Responsibilities:

· Demonstrate critical thinking skills when utilizing the nursing process, based on research, evidence-based outcomes and Standards of Practice to meet patient’s health care needs.

· Gathers and/or analyzes specific CRISP reports to track inpatient admissions in and out-of-network, ED, readmission and high cost utilization of members associated with UMQCN/UMMS providers.

· Create population-based management strategies and processes in collaboration with the Population Health Clinical Program Manager, the site Clinical Director, site Practice Manager, and the site Clinical Coordinator (based on a solid understanding of care management, including disease management and preventive care) that help patients manage their healthcare needs and foster care quality, cost-effectiveness, and patient engagement.

· Recognizes/understands responsibility of this key role and the responsibility this position demands in direct support of high-quality patient care delivery regardless of assignment. This will be measured by the accountability/initiative taken in the performance of daily duties and assignments as itemized in major accountabilities section of job description.

· Establish collaborative partnerships with patients to assist them in examining patterns of health care needs, decisions, lifestyle choices, and utilization of resources that affect their health.

· Communicate effectively with patients, physicians, and their staff on a regular basis.

· Delegates and oversees the care management of lower-risk patients as well as routine chronic disease population management tasks to assigned caregivers.

· Participates in monthly chart audits.

· Ensures compliance with all state and federal regulations and guidelines in day-to-day activities.

· Demonstrates leadership, mentorship and teamwork within dedicated care teams including clinicians, chronic disease care coordinators, medical assistants, pharmacists, social workers and others.

Education and Experience:
* Licensure as a Registered Nurse in the state of Maryland, or eligible to practice due to Compact state agreements outlined through the MD Board of Nursing, is required; BSN preferred.
* 3 to 5 years of care coordination experience and/or experience working in an outpatient ambulatory setting
* Experience with educating patients and patient goal setting (essential)
* Case Management Certification (preferred)
* Experience in a managed care information environment (preferred)
* Preferred experience would include knowledge of quality improvement processes (LEAN or PDSA); practice re-design work such as patient centered medical home, Joint Commission, and National Committee for Quality Assurance (NCQA) accreditations

Job Type: Part-time

Schedule:

• Monday to Friday

Education:

• Bachelor's (Preferred)

Experience:

• care coordination: 3 years (Required)
• patient education and goal setting: 1 year (Required)

License/Certification:

• RN (Required)
• case management (Required)

Work Location: One location

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