Nurse Care Manager

Responsibilities

• Identifies patients for proactive interventions using specific screening criteria, medical record review, payor models, medical risk scores, or referrals.
• Assesses patients' medical, functional, and social conditions per department policy/guidelines to develop individualized care plans and connect them with community resources.
• Develops, maintains, and monitors patient care plans consistent with NCQA and department policies/guidelines, ensuring adherence to medical plans and focusing on prevention measures.
• Supports patient self-management and behavior change using motivational interviewing and coaching techniques.
• Educates healthcare team members about case management processes, appropriate referrals, and advocate for patient rights.
• Collaborates with physicians and other healthcare team members on the patient’s behalf to ensure the patient receives quality and timely care and resolves any delays or issues.
• Develops and maintains collaborative partnerships with hospital care management, post-acute providers, and other care managers to ensure seamless transitions and continuity of care.

• Current Registered Nurse (RN) license in state of practice.
• Bachelor of Science in Nursing (BSN) from an accredited institution (degree verification required).
• RNs hired or promoted into this role must obtain their BSN within four (4) years of hire or promotion.
• Demonstrated clinical nursing experience in chronic disease management, and familiarity with chronic disease terminology and processes.
• Demonstrated understanding of disease management including treatment, length of stay, identifying barriers to delivery of care and any variation.
• Proficiency in basic computer skills and Microsoft Office software.
• Caregivers whose duties require them to conduct home or community visits must maintain current BLS certification, have a current driver’s license, current auto insurance, an acceptable driving record and reliable transportation.