Perm - RN - Community Health Nurse Clinical Care Manager; St. Anthony MN

Position: Perm - RN - Community Health Nurse Clinical Care Manager (Days) St. Anthony MN
Location: Minneapolis

Salary Range:  ,000 -  ,000/year (dependent upon experience)
25% Perm Placement Fee

The Population Health Nurse Care Manager will be responsible for collaborating with clinical care team, population health team, and care coordination team as needed to address customer care management and chronic disease management needs. Blaze Health is a joint venture between Blue Cross and Blue Shield of Minnesota and North Memorial Health, which includes North Memorial Health primary care clinics, specialty care clinics and hospice.

Our customers are at the heart of everything we do. Blaze Health is committed to transforming healthcare to remove the hassle and make it more accessible, more affordable and less complicated. Direct communication between care provider and insurer will help make the care experience better.

At Blaze Health, you're part of an inclusive healthcare team dedicated to delivering a more connected experience for our patients. Caring for our patients and team is at the heart of what we do, and our culture is designed to actively support wellbeing, inspire innovation and encourage growth. Our strength lies in our diversity, and we embrace the unique contributions and experiences of each person.

Together, we're empowering people to achieve their best health.

Occasional travel to other clinic sites and main office at the Fridley clinic is required.


***** More information on the position, per the HM:

"These positions are for our Population Care Manager RN role, this is not a formal leadership position. The RN Care Manager works on a team with a Social Worker and navigator. Together, they work with patients with uncontrolled chronic conditions or ones over using the Emergency Department to come up with a care plan to get them on the right track in terms of their healthcare.

This is a brand new program to North Memorial and they would be joining a very dedicated, enthusiastic team."

Accountabilities:

• The Population Health Nurse Care Manager (PHNCM) conducts comprehensive clinical assessments; gathers, analyzes, synthesizes and prioritizes customer needs and opportunities.

• Collaborates and communicates with customer, family, or designated representative on a plan of care that produces positive clinical results and promotes high-quality effective outcomes.

• Identifies and coordinates referrals to clinical care team members via EHR, i.e., Population Health Social Worker, MTM pharmacy team, Community Paramedics, and Certified Diabetic Educators.

• Facilitates Prescription Assistance and Financial Assistance Program Referrals: identify customers in need due to no insurance or low income, and place referral to Population Health Social Worker.

• ED and Inpatient Discharge Alerts: PHNCM will receive alerts notifying them that a customer attributed to their clinic was discharged from the Emergency Department or Inpatient Unit. Population Health Nurse Care Manager provide those customers with transitional care management (TCM).

• Manages Communication/Care Coordination with hospital, SNF and other healthcare professionals: maintain open communication with inpatient/post-acute care management staff to ensure a smooth transition from acute and post-acute settings to home and timely and appropriate follow up care. Ensure care handoff between levels of care is seamless. Collaborate with other members of healthcare team to include, but not limited to staff from emergency department, inpatient, skilled nursing facility, home health, palliative care, etc.

• Collaborates with clinical care team, population health team, and care coordination team as needed to address customer care needs.

• Identifies participating customers in need of disease management and opportunities for preventative health interventions

• Other duties as assigned by leadership

• Serves as the population health team lead and will work with department leadership to help build and grow this program

• Accepts other duties as assigned to promote the accomplishment of organizational goals.

• The team member is accountable to demonstrate proficiency for the skills outlined in the appropriate position skills list.

• The team member is accountable to maintain skill proficiency, including improvement where deemed necessary, and upgrading any additional or new skills on the appropriate position skills list.

Requirement description :
By submitting your applicant to this need you are acknowledging that you have checked and have no inclination that your candidate has applied directly to this position. Any candidate that has applied directly is not eligible to be onboarded through an agency.

• Graduate from an accredited school of nursing - Required.
• 3-5 Years Ambulatory Care Experience - Preferred
• Care Management/Care Coordination Experience - Preferred
• Strong communication and teaching skills - Required
• Current RN Licensure in the state of Minnesota - Required
• Case Management Experience - Highly Preferred