Nursing Manager Care Coordinator
1 week ago
Job Description: The Nurse Care Manager works collaboratively with physicians and other members of the health care team to improve the health of patients with chronic conditions or complex needs. This position educates patients and families to help them manage their health care needs. The incumbent facilitates communication, coordinates services, addresses barriers, and promotes optimal allocation of resources while balancing clinical quality and cost management.
FTE: Full time
Shift: 40/hrs a week. Hybrid role requires 2 days a week in clinic.
Responds to physician referrals and identifies patients who meet established criteria for care management (e.g. 8, elevated LDL and/or B/P, Mental Health Integration referral, complex resource needs).
Assesses behavioral and family risk factors.
Utilizes a working knowledge of established care process models and other applicable standards of care.
Provides focused patient education using established content and tools.
Uses clinician approved and appropriately documented standing orders.
Establishes individualized care plan including treatment goals in collaboration with patient and consistent with medical plan of care.
Reviews care plan and assesses progress toward treatment goals and barrier at each relevant visit.
Coordinates with care managers in other settings as appropriate.
Maintains list of key community services agencies with contact information.
Personalized Primary Care.
Assesses and tracks patient capacity for and confidence in self-care.
Develops self-care plan in collaboration with patient.
Assesses and arranges treatment for mental health and substance abuse problems.
Manage Populations, Disease Registries and Preventive Care
Establishes process to monitor patient adherence to medical plan of care.
Focuses on prevention measures consistent with established guidelines and care process models
Reviews and manages quality reports related to chronic disease and prevention
Supports clinicians in achieving quality incentives.
Works collaboratively with referring physician and other members of care team
Personalized Primary Care:
Facilitates advanced care planning (Advanced Directives). Establishes a process for reminder letters and phone calls.
Supports clinicians and team to achieve personalized primary care goals.
Facilitates transitions of care (e.g., unscheduled hospital admissions, emergency department visits, skilled nursing home).
In collaboration with clinician, establishes written care plan for patients transitioning from pediatrics to adult.
Provides information on health insurance resources.
Supervises and supports Health Advocates.
Attends clinic team meetings and medical home meetings to assist with process design and help resolve team issues.
Reviews data summary on regular basis.
BLS certification for healthcare providers.
Three years of clinical nursing experience.
Bachelor's degree in Nursing (BSN). Experience in case management, utilization review, or discharge planning.
Ongoing need for employee to see and read information, labels, monitors, identify equipment and supplies, and be able to assess patient needs.
Frequent interactions with patient care providers, patients, and visitors that require employee to verbally communicate as well as hear and understand spoken information, alarms, needs, and issues quickly and accurately, particularly during emergency situations.
Manual dexterity of hands and fingers to manipulate complex and delicate equipment with precision and accuracy. This includes frequent computer use and typing for documenting patient care, accessing needed information, etc.
Moroni Clinic
The hourly range for this position is listed below. Actual hourly rate dependent upon experience.
$We care about your well-being – mind, body, and spirit – which is why we provide our caregivers a generous benefits package that covers a wide range of programs to foster a sustainable culture of wellness that encompasses living healthy, happy, secure, connected, and engaged.
and our commitment to diversity, equity, and inclusion .
Intermountain Health is an equal opportunity employer. Qualified applicants will receive consideration for employment without regard to race, color, religion, age, sex, sexual orientation, gender identity, national origin, disability or protected veteran status.
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