Cardiac Nurse Case Manager

Cardiac Case Manager Register Nurse (RN)

Salary: $81,000-$89,000 per year.

• Patient assessment and planning:
  Conduct comprehensive physical and psychosocial nursing assessments to identify patient needs, goals, preferences and barriers to care. Identify patients with high-cost care, recent hospital admission, high utilization, complex medical needs, or high risk for complications such as hypertension, diabetes, coronary artery disease, congestive heart failure. Develop, implement and evaluate individualized care plans in collaboration with an interdisciplinary team including physicians, nutritionists, behavioral health, etc.
  
  Assist providers with contacting patients to discuss results and additional procedures.
• Provide high-quality care consistent with the scope of a Registered Nurse:
  Provide skilled nursing services, wound care, triage patients for routine, acute, emergent or urgent care, handle patient phone calls and medication refill requests.
• Care coordination and management:
  Facilitate collaborative management of patient care across settings including inpatient and outpatient hospitalizations. Schedule appointments, coordinate follow-up care, referrals to specialists and community resources, track lab tests and diagnostic studies, contact patients overdue for visits, assist with transportation, translation and barrier reduction, and complete medical and prescription forms.
• Patient and family education:
  Educate patients and families about heart conditions, treatment plans, medications, risk factor modification and self-management strategies, test procedures and preparatory instructions.
• Advocacy and communication:
  Serve as a patient advocate, ensuring needs and preferences are considered, and maintain effective communication with the healthcare team, patients, families.
• Monitoring and evaluation:
  Monitor and track patient progress, adjusting care plans as needed to achieve maximum medical improvement, including clinic visits and remote monitoring programs.
• Documentation and quality improvement:
  Maintain accurate patient records in the electronic medical record and participate in performance and quality improvement initiatives, maintain active problem list.
• Perform other duties as assigned by CMO, SVP of Nursing and Clinical Operations and/or their designee.

• Thorough knowledge of practical nursing theory, regulations, anatomy, physiology, aseptic technique, and community resources.
• Excellent communication and interpersonal skills.
• Bilingual Spanish/English preferred.
• Ability to communicate well with patients, staff, and outside providers.
• Adaptability to change.
• Follow instructions given orally or in writing.
• Ability to work independently with little supervision.
• Effective follow-up in all tasks.
• Maintain confidentiality.
• Timely completion of assignments.
• Teamwork.
• Knowledge of Microsoft Office, keyboarding, and electronic medical records.

• Minimum associate’s degree, registered nurse certification and at least two years of related clinical experience.
• Active NJ RN license.
• Prior experience in an ambulatory care or outpatient clinic setting and case management experience preferred.

Entry level.

Full-time.