Registered Nurse Case Manager

Position: REGISTERED NURSE CASE MANAGER
Job Purpose

Chinatown Service Center (CSC) is a multi-service, community health center, which provides compassionate, multi-lingual and culturally sensitive care to the communities of Chinatown, San Gabriel Valley and beyond. Our mission is to provide outstanding services and advocacy that promote better quality of life and equal opportunity for immigrants and other communities. CSC's RN Case Manager provides clinical care coordination for patients enrolled in our Enhanced Care Management (ECM) program, provides Transitional Care Management, and provides case management for the rest of the patients in the medical department.

The Case Manager works with a multidisciplinary team to create Care Plans with specific SMART goals for patients. The Case Manager works with the patient, their support system, and the multidisciplinary team to follow and adjust the care plan as needed based on the patient's progress. The RN Case Manager will support the Medical Director to provide clinical support to the non-clinical ECM team.

The RN Case Manager reports to the Chief Medical Officer (or acting CMO).

Duties and Responsibilities

* Provide care coordination for patients enrolled in ECM.

* Provide Transitional Care Management for patients who have recently been discharged from a higher level of care.

* Works with the patient, their support system and the healthcare team to create a Care Plan with SMART goals for their patients.

* Ensures that Care Plan goals of individual patients are being met.

* Acts as liaison between patient, healthcare team, outside consultants, and any other outside resources to help patient follow their care plan.

* Works closely with the non-clinical ECM Case Management team in the support of their client goals to ensure social determinants of health are addressed.

* Advocates on behalf of members with other healthcare professionals.

* Uses motivational interviewing and trauma informed care practices to engage patients in care.

* Engages and outreaches to eligible case management members.

* Monitors treatment adherence and informs teams of any changes or lack thereof.

* Provides health promotion and self-management training.

* Perform other duties as assigned.

Qualifications

* Graduate of an accredited school of nursing

* Licensed as a Registered Nurse in the state of California

* BLS certification required

* Strong interpersonal skills and critical thinking abilities

* Basic computer and Internet skills: MS Word, Excel, and Internet

* Familiarity with electronic medical record systems and standards of documentation

* Effective oral and written communication skills

* Able to work independently and take initiative

* Establish and maintain effective working relationships with those contacted in the performance of required duties

* Ability to interact with diverse populations and develop good relations with individuals and families

* Able to explain designated and specific regulations and procedures to clients

* Bilingual in English and Chinese/Spanish preferably

Physical Demands

* Must be able to remain in a stationary position 50% of the time.

* Ability to occasionally move about inside the office to access file cabinets, office machinery, etc.

* Able to operate a computer and other office productivity machinery, such as a calculator, copy machine, and computer printer.

* Able to constantly position yourself to maintain files in file cabinets such as reaching with hands and arms, kneeling, crouching, etc.

* The ability to communicate, detect, converse with, discern, convey, express oneself, and exchange information is crucial for this role.