RN Case Manager Outpatient

1 month ago

Acworth, United States Wellstar Health System, Inc. Full time
Job Description

Facility: Acworth Health Park


Job Summary:

As a member of the Population Health Management (PHM) Team, the Outpatient Case Manager works with members, providers and caregivers to provide intensive, comprehensive case management and increase efficient utilization of services for patient with complex needs; identifies chronic, complex and or catastrophic cases through the case management process and or referrals and initiates intensive case management according to program guidelines. This role will utilize multiple disciplines as CM to focus on various different patient populations.
The goal of the PHM OP Case Manager is to effectively manage patients on an outpatient basis and during episodes of acute hospitalizations (in conjunction with their inpatient counterparts) to assure the appropriate level-of-care is provided, optimize safe transition to home or the next level of care, prevent inpatient re-admissions and ensure that the patients' medical, environmental and psychosocial needs are met over the continuum of care. The Case Manager acts as an advocate for members and their families linking them to other appropriate disciplines on the care team to facilitate patient/family education for better self-management, navigation of the health care system, and to identify community resources as necessary.
The PHM OP Case Manager:
- Will be embedded and connect with patients face to face or on the phone
- Telephonic only
Both types will coordinate with other members of the PHM team or multidisciplinary care team to adequately coordinate and manage patient needs
Telephonic Case Management Focus:
Will have a role that primarily the same as the outpatient PHM OP case manager, but will follow patient telephonically only and will support more multiple physician practices or patient populations based on patient volumes.

Core Responsibilities and Essential Functions:

Assessment
- Reviews all patient referrals to determine criteria met for case management.
- Performs comprehensive assessment to identify patient/family needs.
- Identify all high risk areas, including medical, environmental and psychosocial areas
- Reviews all options/resources available to meet client/family needs and to promote optimum health and the most cost effective manner. 20% Planning
- Collaborates with the patient/family, physician and Multidisciplinary team in the formation and modification of a comprehensive and individualized plan of care which addresses the needs and goals of identified high-risk patients with complex chronic conditions.
- Integrates evidence-based clinical guidelines, preventive health guidelines, protocols, and other identified risk information in the development of plans of care that are patient-centric, promoting quality and efficiency in the delivery of healthcare for high risk population.
- Develops and/or utilizes processes that monitor patients across the health continuum with a focus on effective and safe transitions from hospital to home, nursing home or rehab facility with goal of optimizing resources and reduction of avoidable acute care readmissions. 20% Implementation
- Matches the patient/family needs to available and appropriate resources to carry out the plan of care. Utilizes telephonic and face-to-face communication as appropriate to engage with and to meet needs of patients.
- Prioritizes and collaborates with patients/families/healthcare providers regularly to optimize patient engagement and clinical outcomes in the most efficient manner.
- Coordinate patient care services necessary to meet patient needs. Makes appropriate referral to other team members to assist with resource needs.
- A strong emphasis is placed on Wellness, Disease Management and patient education to ensure compliance with the plan of care and prevention of complications with various ailments and chronic conditions.
- Identify care gaps and works with team to close the gaps
- They will coordinate member visits with primary care providers and specialists as needed. 40% Monitoring/Evaluation
- Monitors care through data collection and analysis. Evaluates processes utilizing a systematic approach to determine the effectiveness of the case management plan in terms of reaching desired outcomes and goals to improve the quality, access and cost of care.
- Manages performance feedback metrics to further refine the care model to maximize clinical, quality, and fiscal outcomes for the targeted population.
- Participates in team meetings to evaluate current processes, provide and receive feedback, review specific cases with goal of problem-solving for improved patient adherence to plan of care, clinical outcomes and patient/provider satisfaction. 20%

Required Minimum Education:
Graduate of accredited school of nursing with a current Georgia RN license. Required and
Bachelor's Degree in Nursing Preferred

Required Minimum License(s) and Certification(s):
All certifications are required upon hire unless otherwise stated.

  • Reg Nurse (Single State) or RN - Multi-state Compact
  • Basic Life Support or BLS - Instructor


Additional License(s) and Certification(s):

Required Minimum Experience:

Minimum 5 years in clinical experience Required

Previous Case Management experience
Case Manager certification (CCM) Preferred and
Computer experience with Microsoft office suite and electronic health records Preferred and
Experience in data collection and analysis and basic research techniques desired. Preferred

Required Minimum Skills:

Knowledge of complex case management role and processes.
Demonstrates customer focused interpersonal skills to effectively interact with practitioners, multidisciplinary health care team, community agencies, patients and families with diverse backgrounds, values, and religious/cultural ideals.
Outgoing and autonomous, flexible personality that can engage the geriatric population over the phone
and support the development of PHM CM role..
Demonstrates leadership qualities including excellent organizational and time management skills, verbal and written communication skills, problem-solving, decision-making, priority setting, and work delegation.
Ability to utilize risk-stratification screening criteria, review clinical data in identifying patient/client health care needs.

  • Nurse Manager

    2 months ago

    Acworth, United States Incredible Health Full time

    Hospitals on Incredible Health are actively hiring and accepting applications in the Acworth, GA area for the following position: Nurse Manager - Case Management. Nurses with experience in any of the following areas are strongly encouraged to apply: Assistant Nurse Manager, CNO, Charge, Clinical Nurse Coordinator, Clinical pathway, Director, Manager,...

  • Healthcare Services Manager

    2 weeks ago

    Acworth, Georgia, United States Benchmark Human Services Full time

    Benchmark Human Services, a national leader in providing services to individuals with disabilities and mental illness, is seeking an experienced RN Nurse Manager to join its team.The ideal candidate will have a strong background in supervising health services and ensuring quality care delivery. Key responsibilities include providing staff training, direct...

  • Clinical Care Manager for Complex Patient Populations

    2 weeks ago

    Acworth, Georgia, United States Wellstar Health System, Inc. Full time

    Job OverviewWellstar Health System, Inc. is seeking a skilled Clinical Care Manager to join our team in Acworth, Georgia. As a key member of our Population Health Management team, you will work with patients, providers, and caregivers to deliver comprehensive care management services.ResponsibilitiesAssessment: Conduct thorough patient assessments to...

  • Nursing Leadership Professional

    2 weeks ago

    Acworth, Georgia, United States Incredible Health Full time

    ["Hiring for a Nurse Manager - Case Management position at Incredible Health in Acworth, GA. Key Responsibilities:• Manage case loads and coordinate patient care with the healthcare team.• Oversee nursing staff and ensure quality patient care standards are met.• Develop and implement nursing policies and procedures to improve patient outcomes.•...

  • Healthcare Leadership Professional

    2 weeks ago

    Acworth, United States Incredible Health Full time

    Hospital Nursing Management opportunities are currently available in the Acworth, GA area with Incredible Health. As a Nurse Manager - Case Management, you will oversee nursing staff and departments to ensure high-quality patient care and efficient hospital operations.Key Responsibilities:Lead and manage nursing teams to achieve organizational goals and...

  • Home Healthcare Nurse Specialist

    2 weeks ago

    Acworth, Georgia, United States Aveanna Healthcare Full time

    Job SummaryAveanna Healthcare is seeking a compassionate and skilled Home Healthcare Nurse Specialist to provide high-quality care to patients in the comfort of their own homes.About the JobThis role requires a dedicated LPN/LVN to work with our clients, providing one-on-one care and support. The successful candidate will be responsible for implementing...

  • In Home Nursing LPN

    4 weeks ago

    Acworth, United States Aveanna Healthcare Full time

    Requisition #:198991 Location:Acworth, GA 30101 Category:LPN/LVN Salary:$36.00 per hour Position Details Private Duty Nurse LPN Multiple shifts in Acworth Our local office is looking for a team of compassionate nurses to provide care for a very special client/patient. Here are some of the details of this case, more can be discussed by applying or...

  • Healthcare Operations Director

    2 weeks ago

    Acworth, United States Incredible Health Full time

    Job OverviewIncredible Health is seeking a seasoned Nurse Manager to oversee Case Management operations in the Acworth, GA area. This role offers a unique opportunity for experienced nurses to take on leadership responsibilities and drive excellence in patient care.Key ResponsibilitiesOversee day-to-day Case Management operations, ensuring seamless...

  • In Home Nursing LPN

    2 weeks ago

    Acworth, United States Aveanna Healthcare Full time

    Private Duty Nurse LPNMultiple shifts in AcworthOur local office is looking for a team of compassionate nurses to provide care for a very special client/patient. Here are some of the details of this case, more can be discussed by applying or contacting the local office: Schedule: Friday-Sunday 7a-11p (Open to variation of shifts/2 nurses to fulfill...

  • In Home Nursing LPN

    4 weeks ago

    Acworth, United States Aveanna Healthcare Full time

    Private Duty Nurse LPNMultiple shifts in AcworthOur local office is looking for a team of compassionate nurses to provide care for a very special client/patient. Here are some of the details of this case, more can be discussed by applying or contacting the local office: Schedule: Friday-Sunday 7a-11p (Open to variation of shifts/2 nurses to fulfill...

  • In Home Nursing LPN

    1 week ago

    Acworth, United States SimplyApply Full time

    Private Duty Nurse LPNMultiple shifts in AcworthOur local office is looking for a team of compassionate nurses to provide care for a very special client/patient. Here are some of the details of this case, more can be discussed by applying or contacting the local office: Schedule: Friday-Sunday 7a-11p (Open to variation of shifts/2 nurses to fulfill hours)...

  • In Home Nursing LPN

    1 week ago

    Acworth, United States Aveanna Healthcare Full time

    Private Duty Nurse LPNMultiple shifts in AcworthOur local office is looking for a team of compassionate nurses to provide care for a very special client/patient. Here are some of the details of this case, more can be discussed by applying or contacting the local office: Schedule: Friday-Sunday 7a-11p (Open to variation of shifts/2 nurses to fulfill hours)...

  • In Home Nursing LPN

    2 weeks ago

    Acworth, United States Aveanna Healthcare Full time

    Private Duty Nurse LPNMultiple shifts in AcworthOur local office is looking for a team of compassionate nurses to provide care for a very special client/patient. Here are some of the details of this case, more can be discussed by applying or contacting the local office: Schedule: Friday-Sunday 7a-11p (Open to variation of shifts/2 nurses to fulfill...

  • In Home Nursing LPN

    3 weeks ago

    Acworth, United States Aveanna Healthcare Full time

    Private Duty Nurse LPNMultiple shifts in AcworthOur local office is looking for a team of compassionate nurses to provide care for a very special client/patient. Here are some of the details of this case, more can be discussed by applying or contacting the local office: Schedule: Friday-Sunday 7a-11p (Open to variation of shifts/2 nurses to fulfill...

  • In Home Nursing LPN

    3 weeks ago

    Acworth, United States Aveanna Healthcare Full time

    Private Duty Nurse LPNMultiple shifts in AcworthOur local office is looking for a team of compassionate nurses to provide care for a very special client/patient. Here are some of the details of this case, more can be discussed by applying or contacting the local office: Schedule: Friday-Sunday 7a-11p (Open to variation of shifts/2 nurses to fulfill hours)...

  • In Home Nursing LPN

    1 month ago

    Acworth, United States Aveanna Healthcare Full time

    Job DescriptionJob DescriptionPrivate Duty Nurse LPNMultiple shifts in AcworthOur local office is looking for a team of compassionate nurses to provide care for a very special client/patient. Here are some of the details of this case, more can be discussed by applying or contacting the local office: Schedule: Friday-Sunday 7a-11p (Open to variation of...

  • In Home Nursing LPN

    3 weeks ago

    Acworth, United States Disability Solutions Full time

    Private Duty Nurse LPNMultiple shifts in AcworthOur local office is looking for a team of compassionate nurses to provide care for a very special client/patient. Here are some of the details of this case, more can be discussed by applying or contacting the local office: Schedule: Friday-Sunday 7a-11p (Open to variation of shifts/2 nurses to fulfill...

  • Dynamic Behavioral Therapist Leader

    2 weeks ago

    Acworth, Georgia, United States Titan Placement Group Full time

    Seeking a Dedicated Board Certified Behavior AnalystA challenging opportunity has arisen for a Board Certified Behavior Analyst (BCBA) in Acworth, GA.We invite you to explore this chance to work in a beautiful town surrounded by two magnificent lakes - lakes Acworth and Allatoona - offering ample opportunities for outdoor activities such as swimming,...

  • Board Certified Behavior Analyst

    2 months ago

    Acworth, United States Titan Placement Group Full time

    Job DescriptionJob DescriptionBoard Certified Behavior Analyst (BCBA)A Board-Certified Behavior Analyst (BCBA) is needed in Acworth, GA.Titan Placement Group invites you to explore a heartfelt opportunity in a town that is home to two magnificent lakes - lakes Acworth and Allatoona - with swimming, fishing, boating and sailing opportunities. Shoppers enjoy...

  • Licensed Talk Therapist

    7 months ago

    Acworth, United States Thriveworks Full time

    Thriveworks is currently seeking Licensed Clinicians to provide a mix of telehealth and face-to-face sessions in Atlanta, GA. ***For a limited time, we are offering a $2,000 SIGN ON BONUS!*** Thriveworks is a clinician-founded national private practice group with locations in 48 states. Our mission is to help people live happy, successful lives, and we...