Clinical Care Manager

Gifford Medical Center; Randolph (VT); In loco; USD 60.000 - 80.000; Tempo pieno

Vantaggi offerti da questo lavoro

Competitive wages

Onsite parking

Health plans including dental and vis​

Tax-saving flexible spending accounts

Health Savings Plan with employer con​

Long and short-term disability

Descrizione del lavoro

Gifford Health Care in Vermont seeks a Community Health Team Spoke Nurse Care Manager to provide comprehensive care management and care coordination for patients with complex health, behavioral health, and social needs within our Addiction Medicine program.

Working with patients, providers, and community partners, you will help individuals access appropriate services, strengthen self-management skills, and facilitate transitions from emergency departments or hospitalizations under Vermont's Hub

Competenze

• Current Vermont license as an LPN or RN, or other qualifying healthcare professional as approved under Vermont Blueprint for Health Community Health Team standards.
• Experience in care management, care coordination, behavioral health, chronic disease management, or community-based services preferred.
• Strong communication, motivational interviewing, and patient engagement skills.

Mansioni

• Provide comprehensive care management and care coordination for patients with complex health, behavioral health, and social needs.
• Facilitate access to appropriate healthcare services and connect patients with community resources and benefits.
• Promote self-management skills and work with patients to build ongoing health plans.
• Coordinate transitions of care and support continuity of care within the Addiction Medicine program.

Conoscenze

Communication skills

Motivational interviewing

Patient engagement

Formazione

Vermont license as LPN or RN

Descrizione del lavoro

Gifford Health Care is seeking a Community Health Team Spoke Nurse Care Manager to join our Vermont Blueprint for Health team. In this role, you will provide comprehensive care management and care coordination services for patients with complex health, behavioral health, and social needs within our Addiction Medicine program. Working collaboratively with patients, providers, and community partners, you will help individuals access appropriate healthcare services, improve health outcomes, and build self-management skills.

The Care Manager ensures patients maintain an active relationship with a Primary Care Provider (PCP) and facilitates access to high-quality, evidence-based healthcare services, while helping patients connect with community-based programs, resources, and benefits that support overall health and well-being.

As part of Vermont's Hub and Spoke model, the Care Manager provides comprehensive care management, care coordination, health promotion, and transitional care services following emergency department visits or hospitalizations. This role also provides individual and family support, facilitates referrals to community services, Community Health Team programs, and Primary Care Providers, and empowers patients to develop effective self-management skills.

Areas of focus may include infectious disease prevention and education, tobacco cessation, pregnancy and prenatal support, parenting skills, co-occurring mental health conditions, dental health, nutrition, personal hygiene, and chronic disease management, including hypertension, diabetes, obesity, coronary artery disease, chronic pain, and depression.

Working closely with healthcare providers, community agencies, and the broader Community Health Team, this role supports continuity of care and helps patients successfully navigate healthcare and social service systems. Confidentiality and adherence to Gifford Health Care policies and procedures are essential.

Requirements:

• Current Vermont license as an LPN or RN, or other qualifying healthcare professional as approved under Vermont Blueprint for Health Community Health Team standards.
• Experience in care management, care coordination, behavioral health, chronic disease management, or community-based services preferred.
• Strong communication, motivational interviewing, and patient engagement skills.
• Ability to work independently and collaboratively within an interdisciplinary team.

Gifford Health Care offers competitive compensation and a comprehensive benefits package. Our Total Rewards package includes, but is not limited to:

• Competitive wages
• Onsite parking
• Health plans including dental and vision insurance
• Tax-saving flexible spending accounts
• Health Savings Plan with employer contribution
• Long and short-term disability insurance