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Registered Nurse Care Coordinator
2 months ago
Position : RN Care Manager
Employee Category : Exempt
Reporting Relationship : Population Health Manager
Essential Qualities:
- Alertness- Maintaining awareness of surroundings to respond appropriately.
- Dependability- Committing to responsibilities, even at a personal cost.
- Flexibility- Adapting to changes in plans or ideas without frustration.
- Sensitivity- Perceiving the genuine feelings and attitudes of others.
The RN Care Manager is a vital role focused on supporting Variety Care's most vulnerable patients, particularly those at high risk. Collaborating with the healthcare team, the RN Care Manager is tasked with organizing, coordinating, and delivering care management services to patients at risk of health decline, adverse health outcomes, or unnecessary emergency care usage.
Key Responsibilities:
Oversee the care of Variety Care's high-risk patient demographic. Perform thorough assessments of patients' physical, mental, and emotional needs. Create care plans aimed at preventing health deterioration, enhancing outcomes, fostering patient involvement in self-care, reducing risk factors, and minimizing hospital and emergency room visits. Accurately and regularly update patients' medication lists. Facilitate communication with healthcare providers (including specialists, therapists, nutritionists, and social workers) to ensure efficient information exchange. Employ behavioral strategies such as Bridges out of Poverty, Crucial Conversations, and Teach-Back techniques to encourage self-management and healthy behavior adoption. Maximize the use of Variety Care's available services, including Behavioral Health, Social Services, Community Health Workers, and more. Lead a subset of patients designated by the Population Health Manager, working with the care management team to maintain medical stability and enhance quality of life. Ensure that necessary services, equipment, and supplies are coordinated and verified. Engage in regular case staffing meetings and reviews. Follow up with patients post-discharge and after emergency department visits. Collaborate with external case management programs for coordinated care. Continuously evaluate and document patient progress and risk status. Work closely with internal care teams for effective collaboration. Document care coordination activities accurately in the electronic health record. Support Variety Care's initiatives related to care coordination. Actively participate in team-based care initiatives. Collaborate with Variety Care staff to develop integrated care management programs. Serve as a professional role model for colleagues. Adhere to all Variety Care policies and procedures. Contribute to Variety Care's accreditation as a Patient-Centered Medical Home, ensuring care is Safe, Effective, Patient-Centered, Timely, Efficient, and Equitable. Work towards achieving the goals of healthcare reform's "Triple Aim" - enhancing care experience, improving health outcomes, and reducing costs. Represent Variety Care on community boards and task forces. Exhibit strong personal character, valuing open and honest communication, integrity, adaptability, and sound judgment. Demonstrate leadership within the department and community. Be a responsible and accountable problem solver. Perform additional duties as assigned. Qualifications and Skills Required :
Active RN License in good standing in the state of Oklahoma. Exceptional oral and written communication skills. Preferred Qualifications and Skills :
Two years of experience in care management within a community-based environment. Bachelor of Science Degree in Nursing is preferred. Bilingual (English/Spanish). Physical Requirements :
Must be able to lift 25 pounds.
