Chronic Care Nurse

6 days ago


Roseburg, United States Evergreen Family Medicine, PC Full time
Chronic Care Nurse

Evergreen Family Medicine is committed to providing excellent care for your family with clinics in
Roseburg, Sutherlin and Myrtle Creek Oregon. Evergreen Family Medicine serves outpatient needs, including
Urgent Care, Family Practice, Women’s Health, Occupational Health, and school-based telehealth.

Evergreen Family Medicine is a Drug Free Workplace. All candidates that are offered employment will
be required to pass a pre-employment drug screen and background check.

The Chronic Care Manager provides chronic care/clinical case management services aimed at enhancing
patient-centered care and maximizing outcomes across the patient care continuum. Case management
services include patient advocacy, monitoring patient care to ensure progress toward desired outcome,
addressing patient and family needs, resolving obstacles to effective care, and implementing disease
modifying interventions.

Responsibilities and Duties:
  • Maintains confidentiality according to HIPPA regulations and EFM policies
  • Adheres strictly to EFM departmental standards and policies, including state and federal
    regulations.
  • Communicates effectively and professionally with coworkers, managers, and patients via phone,
    email, or in person.
  • Coordinates the case management process from the patient’s admission to discharge and followup
    care, including ER follow up care.
  • Capable of assessment of physical functioning as well as an understanding of both acute and
    chronic illness and disability.
  • Identifies patients who are suitable for chronic acre/case management intervention. Seeks
    authorization for chronic care/case management services for families.
  • Assess needs of patients/family, coordinates care and resources. Plans, develops, and implements
    appropriate patient care goals.
  • Familiarity with community support services and resources. Knowledge of relationships among
    medical, psychological, and behavioral components of illness/injury.
  • Monitors and documents quality of care to ensure patient care plan goals and appropriate and
    understood as well as implemented. Identifies patient needs, including those of ethical and
    cultural nature and assures that they are addressed.
  • Assists with finding resources that can help with funding for medications and insurance issues.
  • Identifies delays in service request or treatments and communicates them to the healthcare team.
  • Establishes measurable chronic acre/case management goals that promote cost-effective, highquality
    outcomes.
  • Provides and/or assists in diabetic education, smoking cessation, and wound care management.
  • Visits patients in care facilities and performs Chronic Care Management Services
  • Performs other duties as assigned.
Qualifications and Skills:
  • Degree, license or certification in LPN or RN.
  • Communication, interpersonal, clerical, and organizational skills necessary to complete job
    duties.
  • Ability to handle the confidential aspects of the work.
  • The ability to type at least 40 wpm and activate/operate computers and office equipment.
Physical requirements:
  • Prolonged periods sitting at a desk and working on a computer.
  • The employee is frequently required to walk; use hands and fingers, handle, or feel; and reach
    forward with hands and arms.
  • The employee is occasionally required to sit and stoop, kneel, or crouch.
  • May be exposed to patients with infectious diseases.
  • Must be able to lift up to 35 pounds at times.
Our culture and values are every employee’s responsibility: The needs of our patient come first
S.P.I.R.I.T
  • Stewardship
  • Patient & Population Focused Health Care
  •  Integrity
  • Respect
  • Innovation
  • Teamwork
Benefits: 


  • Health, Dental, Vision benefits 
  • Life Insurance 401k with a company match up to 6% 
  • Paid Time Off 

Compensation:  Dependent on licensure and experience 


  • Chronic Care Nurse

    4 weeks ago


    Roseburg, United States Evergreen Family Medicine Full time

    Evergreen Family Medicine is committed to providing excellent care for your family with clinics in Roseburg, Sutherlin and Myrtle Creek Oregon. Evergreen Family Medicine serves outpatient needs, including Urgent Care, Family Practice, Women’s Health, Occupational Health, and school-based telehealth. Evergreen Family Medicine is a Drug Free Workplace. All...

  • Chronic Care Nurse

    3 hours ago


    Roseburg, United States Evergreen Family Medicine, PC Full time

    Evergreen Family Medicine is committed to providing excellent care for your family with clinics in Roseburg, Sutherlin and Myrtle Creek Oregon. Evergreen Family Medicine serves outpatient needs, including Urgent Care, Family Practice, Women’s Health, Occupational Health, and school-based telehealth. Evergreen Family Medicine is a Drug Free Workplace. All...


  • roseburg, United States Innovative Renal Care Full time

    Registered Nurse, RNOur Registered Nurses provide high quality patient care to patients suffering from the most advanced stage of chronic kidney disease, known as End Stage Renal Disease (ESRD). Nurses are on the front line of patient care, improving the quality of life of every patient. This role is all about the relationships and bond you will create with...

  • Community Care RN

    2 days ago


    Roseburg, United States Innovative Renal Care Full time

    Registered Nurse, RN Our Registered Nurses provide high quality patient care to patients suffering from the most advanced stage of chronic kidney disease, known as End Stage Renal Disease (ESRD). Nurses are on the front line of patient care, improving the quality of life of every patient. This role is all about the relationships and bond you will create...

  • Registered Nurse

    7 days ago


    Roseburg, Oregon, United States Nurses First Solutions Full time

    Nurses First Solutions, a leading staffing agency for nurses, is seeking an experienced Registered Nurse (RN) to join our team in Roseburg, Oregon. As a Progressive Care Unit specialist, you will be responsible for providing high-quality patient care and educating patients and their families about various health conditions.About the JobLocation: Roseburg,...


  • Roseburg, Oregon, United States Innovative Renal Care Full time

    Educate prospective patients on the comfort and freedom offered by home dialysis modalityTrain patients on their chosen home dialysis modalityCollaborate with nephrologists to develop personalized treatment plansProvide educational workshops on the latest technologies and evidence-based practices


  • Roseburg, Oregon, United States Nurse First Full time

    Nurse First is seeking a travel nurse RN for a PCU - Progressive Care Unit position in Roseburg, Oregon. This 13-week assignment offers an attractive compensation package based on 12-hour shifts and 36 hours per week.About the RoleJob Type: Travel NursingSpecialty: Critical CareDiscipline: Registered Nurse (RN)The ideal candidate will have experience working...

  • Critical Care Nurse

    1 week ago


    Roseburg, Oregon, United States Catholic Health Initiatives Full time

    We are seeking a skilled Critical Care Nurse to join our team at Catholic Health Initiatives in Roseburg, Oregon.As a PCU Nurse, you will work collaboratively with the interdisciplinary healthcare team to provide patient care of considerable difficulty and utilize the nursing process to assess, plan, implement, and evaluate care given to patients.Key...


  • Roseburg, Oregon, United States Catholic Health Initiatives Full time

    OverviewCatholic Health Initiatives offers a unique opportunity to advance your career in a supportive and rewarding work environment. Our organization is guided by core values of Compassion, Inclusion, Integrity, Excellence, and Collaboration. These principles are reflected in our interactions with patients and colleagues alike.Roseburg, situated in...


  • Roseburg, United States Nurse First Full time

    Nurse First, a leading travel agency dedicated to empowering nurses, is seeking a skilled RN for a travel nursing job in Oregon.**Job Summary:**We are looking for a highly motivated and experienced Registered Nurse (RN) with expertise in PCU - Progressive Care Unit to join our team as a travel nurse. The ideal candidate will possess excellent communication...

  • Registered Nurse

    5 months ago


    Roseburg, United States Innovative Renal Care Full time

    Registered Nurse, RN Our Registered Nurses provide high quality patient care to patients suffering from the most advanced stage of chronic kidney disease, known as End Stage Renal Disease (ESRD). Nurses are on the front line of patient care, improving the quality of life of every patient. This role is all about the relationships and bond you will create with...


  • Roseburg, United States Nurses First Solutions Full time

    Nurses First Solutions is a leading healthcare staffing agency that specializes in connecting skilled professionals with exciting travel nursing opportunities.About the JobWe are currently seeking an experienced Critical Care Registered Nurse to join our team on a 13-week contract in Roseburg, Oregon. This position offers a unique blend of challenge and...

  • Registered Nurse

    3 weeks ago


    Roseburg, United States Innovative Renal Care Full time

    Registered Nurse, RN Our Registered Nurses provide high quality patient care to patients suffering from the most advanced stage of chronic kidney disease, known as End Stage Renal Disease (ESRD). Nurses are on the front line of patient care, improving the quality of life of every patient. This role is all about the relationships and bond you will create...


  • Roseburg, United States Nurse First Full time

    Nurse First Travel Agency:We are dedicated to providing travel nurses with the best experience possible, focusing on patient care and exploration of new places without worries.About the Job:As a Critical Care Nurse, you will be working in the Progressive Care Unit (PCU) at a hospital in Roseburg, Oregon. This is a 13-week assignment, with 36 hours per week,...


  • Roseburg, United States Nurse First Full time

    OverviewNurse First, a renowned travel nursing agency, is seeking an experienced Critical Care Registered Nurse to join their team for a 13-week assignment in Roseburg, Oregon. This opportunity offers a unique chance to provide exceptional patient care while exploring the Pacific Northwest.About Nurse FirstNurse First Travel Agency is dedicated to providing...


  • Roseburg, United States Nurses First Solutions Full time

    We are seeking a dedicated Critical Care travel nurse to join our team at Nurses First Solutions.About the OpportunityAs a critical care travel nurse, you will provide exceptional patient care and education in a dynamic environment. This 13-week assignment offers a unique chance to develop your skills and contribute to the well-being of patients in Roseburg,...

  • Registered Nurse

    2 weeks ago


    Roseburg, United States Innovative Renal Care Full time

    Registered Nurse, RN Our Registered Nurses provide high quality patient care to patients suffering from the most advanced stage of chronic kidney disease, known as End Stage Renal Disease (ESRD). Nurses are on the front line of patient care, improving the quality of life of every patient. This role is all about the relationships and bond you will create with...

  • Registered Nurse

    4 weeks ago


    Roseburg, United States Innovative Renal Care Full time

    Registered Nurse, RN Our Registered Nurses provide high quality patient care to patients suffering from the most advanced stage of chronic kidney disease, known as End Stage Renal Disease (ESRD). Nurses are on the front line of patient care, improving the quality of life of every patient. This role is all about the relationships and bond you will create with...

  • Registered Nurse

    1 month ago


    Roseburg, United States Innovative Renal Care Full time

    Registered Nurse, RN Our Registered Nurses provide high quality patient care to patients suffering from the most advanced stage of chronic kidney disease, known as End Stage Renal Disease (ESRD). Nurses are on the front line of patient care, improving the quality of life of every patient. This role is all about the relationships and bond you will create with...

  • Registered Nurse

    3 weeks ago


    Roseburg, United States Innovative Renal Care Full time

    Description Registered Nurse, RN Our Registered Nurses provide high quality patient care to patients suffering from the most advanced stage of chronic kidney disease, known as End Stage Renal Disease (ESRD). Nurses are on the front line of patient care, improving the quality of life of every patient. This role is all about the relationships and bond you will...