Outpatient Clinical Care Manager
3 weeks ago
SUMMARY: The Outpatient Clinical Care Manager (RN) is responsible for working with and providing clinical support for an identified group of patients and families and managing their ongoing health treatment plan. The Clinical Care Manager (RN) actively supports the clinical care needs of the patients cared for by the physician they are aligned with within the outpatient clinic. The Clinical Care Manager uses critical thinking skills and nursing expertise to ensure the timely completion of both clinical and episodic care coordination and ensures the successful attainment of HEDIS and other quality-related needs.
Approximately 80% of the time is spent on inpatient care-related activities, and 20% on other nursing activities.
- Utilizes knowledge, skill, and expertise in pediatrics and/or a specialty to coordinate the clinical care of pediatric patients throughout the healthcare continuum. May evaluate patients via the intake process to determine the appropriateness of patients for services provided at La Rabida.
- Assists the physician in all aspects of the consultation, treatment plan execution, and follow-up care needs of the patient.
- Conduct a review of and education with the patient/family as it relates to the physician-prescribed treatment plan.
- Facilitates clinic huddles with an advance review of scheduled patients and updates clinical team as to clinical support service that may be needed, conducts follow-up on labs, ensures patient compliance with outside referral adherence, and identification of needed clinical care and quality gaps.
- Responsible for the submission of prior authorization requests, while adhering to payer guidelines, for physician-ordered patient DME equipment, medications, and supplies. Provides patient/family education on the use of prescribed equipment.
- Provides intermittent/as-needed patient follow-up between clinic visits. Monitors patient quality/care gap needs and ensures completion prior to patient discharge from clinic visit.
- Serves as clinical team liaison for families, care coordination entities, external agencies, and other internal/external individuals providing services to specific families. Assists with the completion of plans of treatment, prescriptions, school forms, and other similar documents as needed and with the approval of the medical provider. Delegates appropriate patient follow-up needs to the Access Center as requests are received.
- Consults on patient care issues in areas of expertise and functions as a resource to the nursing staff as well as members of the community. May perform specific clinical assessments or procedures for patients if trained and competent to do so.
Additional Functions:
Performs other duties as assigned.
Employees are required to maintain automobile insurance if the position requires travel in relation to LaRabida-related business. La Rabida strongly recommends that the employee maintain the following liability limits: Automobile liability: $100,000 per person, per accident; Bodily injury: $300,000 aggregate per accident; Property damage: $50,000 per accident; Automobile medical payments: $1000 per person.
QUALIFICATIONS:
Education: Graduate of an approved school of professional nursing. BSN required, MSN preferred
Related Work Experience: Three years of experience in pediatric nursing required
Experience in care management or a clinical specialty is desirable
Licensure/Certification: Current Illinois Professional Nursing Licensure; APN license if appropriate. Certification in Pediatric Nursing, Case Management, or specialty preferred.
Specialized Knowledge and Skills: Excellent written and verbal communication skills, excellent interpersonal skills, demonstrated knowledge and expertise in pediatrics and any specialty areas, as well as family education; Active membership in appropriate professional organizations; Ability to speak Spanish desirable.
CPR required: Only certifications issued by the American Heart Association or the American Red Cross will be accepted.
Conditions of Employment Required to demonstrate full vaccination status for Coronavirus Disease 2019 (COVID-19) with a Food and Drug Administration (FDA) authorized or FDA-approved COVID-19 vaccine; OR Qualify for a reasonable accommodation for an exemption from vaccine requirements based on a medical disability or because of a sincerely held religious belief. Additional information and instructions regarding how to request a reasonable accommodation will be provided on request at the time of selection.
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