Clinical Care Manager RN

1 week ago

Raleigh, North Carolina, United States UNC Health Full time

Position Overview

At UNC Health, we are dedicated to enhancing healthcare delivery through our statewide clinically integrated network and population health services. Our mission is to provide innovative, patient-centered solutions to a diverse range of populations covered under alternative payment models. As part of our team, you will collaborate with healthcare providers, practices, payers, business leaders, and community partners to elevate the quality and accessibility of care while reducing costs for patients and stakeholders.

Role Summary:
The RN Care Manager is integral in delivering comprehensive and coordinated care to patients within the UNC Health framework. This role requires a blend of skills, including risk assessment, patient evaluations, personalized care planning, care transitions, delegated responsibilities, and effective communication with payers. The Care Manager works in partnership with healthcare professionals, patients, and their families to ensure optimal care and support throughout the patient's healthcare journey.

Key Responsibilities:
1. Patient Evaluations:
a. Perform thorough assessments using standardized tools and nursing expertise to evaluate patients' functional capabilities, cognitive health, and psychosocial support systems.
b. Identify barriers to care and formulate appropriate interventions.
2. Personalized Care Plans:
a. Collaborate with healthcare providers, patients, their families, and the care team to develop individualized care plans that reflect patients' goals and preferences.
b. Ensure care plans are evidence-based, culturally appropriate, and encourage patient engagement and self-management.
3. Risk Assessment:
a. Utilize standardized instruments and clinical judgment to determine patients' risk levels based on various factors, including medical conditions and social determinants of health.
b. Create strategies to manage and mitigate risks effectively, ensuring patients' overall well-being and health outcomes.
4. Coordinated Interventions:
a. Organize and facilitate necessary interventions to support care plans.
b. Collaborate with healthcare providers and community resources to ensure seamless care coordination.
c. Advocate for patients' needs and rights, ensuring timely and appropriate interventions.
d. Participate in quality improvement initiatives to meet or exceed patient and organizational goals.
5. Care Transitions:
a. Oversee and facilitate care across various healthcare settings, ensuring continuity and seamless transitions.
b. Communicate and collaborate with healthcare providers and community resources for comprehensive care delivery.
c. Facilitate multidisciplinary meetings to discuss patients' care plans and progress.
6. Collaborative Coordination:
a. Coordinate care management tasks with other healthcare team members while maintaining accountability for overall patient care management.
7. Payer Collaboration:
a. Work with payers and insurance companies to optimize reimbursement and facilitate timely approvals for necessary services.
8. Documentation:
a. Accurately document and bill for services rendered, ensuring compliance with insurance and regulatory standards.
b. Collaborate with billing professionals to meet coding and documentation requirements.
9. Longitudinal Care:
a. Serve as a primary contact and advocate for patients within the care team.
b. Provide ongoing support and coordination throughout the patient's healthcare journey, ensuring comprehensive care delivery.

Additional Information:
Education:
Graduation from an accredited nursing program is required.
Licensure:
Must hold a valid RN license in North Carolina.
Experience:
A minimum of 2 years of nursing experience is required.
Skills:
Strong knowledge of risk assessment, patient evaluations, personalized care planning, care transitions, and payer communication is essential. Excellent communication, collaboration, and problem-solving skills are necessary, along with proficiency in electronic health records (EHR) and relevant software applications.

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