Nurse Care Mgr

Rhode Island Hospital; Providence (RI); Híbrido; USD 75.000 - 110.000; Jornada completa

Descripción de la vacante

Brown University Health invites applications for a Nurse Care Manager in Warwick, RI, working Mon-Fri 8:00am-5:00pm with one remote day. The role collaborates with the care team to promote patient-centered care and manage high-risk patients within a medical home model.

Responsibilities include care coordination, patient education and utilizing EMR systems to drive quality outcomes. Strong teamwork and communication are essential to success in this role.

Formación

• Licensed RN in Rhode Island.
• Experience in primary care or care management preferred.
• Ability to educate patients and develop care plans.

Responsabilidades

• Collaborate with care team to case manage high-risk patients in primary care.
• Set up and implement the primary care medical home model and coordinate care plans.
• Coordinate communication among providers, staff and patients to improve outcomes.
• Provide disease education and self-management support for chronic conditions.
• Utilize EMR and reporting to monitor service volume and quality metrics.

Conocimientos

Care coordination

Nurse case management

Interdisciplinary collaboration

Motivational interviewing

Educación

RN licensure Rhode Island

Herramientas

Electronic Medical Record (EMR)

Current Care registry

Descripción del empleo

SUMMARY

This role is located on 43 Jefferson Blvd in Warwick, RI

Monday - Friday 8:00am - 5:00pm with the flexibility of one remote day

The Nurse Care Manager reports to the Director of Clinical Operations and the Administrative Director for Primary Care and Clinical Integration. Under the general supervision of the Practice Physician Medical Director, and departmental policies, the Nurse Care Manager is integrated into the practice-based healthcare team to work in partnership to promote patient-centered care, maintaining frequent contact with the primary care providers and medical home team members. The Nurse Care Manager will enhance delivery of care and promote care while actively participating in interdisciplinary patient-centered team meetings and huddles/collaborative care rounds. All essential functions performed in this position reflect the age specific needs of the patients.

Brown University Health employees are expected to successfully role model the organization's values of Compassion, Accountability, Respect, and Excellence as these values guide our everyday actions with patients, customers and one another.

RESPONSIBILITIES

• Works collaboratively with the care team to identify and case manage patients with a high risk of adverse health outcomes in a primary care setting ensuring open communication patient status with providers and office staff.
• Sets up and implements primary care medical home model and administers evidence-based healthcare, utilizing innovative thinking and understanding of healthcare delivery system access points and services.
• Facilitates communication between members, providers, and stakeholders to coordinate and implement action plans aimed at improving the patients' total health and attaining desired patient outcomes.
• Provides comprehensive screenings, assessments, care coordination services, disease education and self-management support with patients who have chronic health conditions, with particular attention to diabetes, depression and coronary artery disease in the office or home setting as needed.
• Provides detailed education to patients about their specific chronic illness, including pathology signs and symptoms, complications and medications used in treatment.Conducts and/or reviews medication reconciliation and works with provider/team pharmacist as needed to assist with medication management to support patients to enhance medication adherence.
• Works one-on-one with patients meeting individual healthcare needs; develops a plan of care, interventions and treatment goals with patients that promote improved health outcomes and quality of life and reviews with provider and clinical team members.
• Addresses barriers to optimum patient health; advocate for patients to ensure access and timely service delivery across the continuum of care. Ensures safe, effective and efficient care for all patients transferring to home from the Emergency Department; responsible for timely telephonic follow up of complex patients who present to the ED.
• Utilizes behavior techniques, such as motivational interviewing, to assist patients with establishing self-management goals and action plans with timeframes.
• Acting as a liaison, coordinates care and performs outreach identifying and utilizing cultural and community resources; providing access to culturally and linguistically appropriate services as needed.Utilizes an interdisciplinary team approach to address opportunities to plan and coordinate care; acts in a supportive capacity to other team members (medical assistants, patient service representatives, practice managers, providers, etc.) in supporting patients and their treatment plan.
• Utilizes the Electronic Medical Record (EMR), chronic disease registry, and Current Care reporting to prioritize patient follow-up.Generates quarterly reports on service volume, distribution of patients by plan, and types of services provided; analyzes data and develops and implements performance improvement strategies to meet and exceed quality of care expectations.
• Maintains knowledge of contemporary, professional nursing practice within the legal framework of Rhode Island Nurse Practice Act.
• Attends training and retraining as needed, to maintain current knowledge of patient's care practices and procedures.
• Shares best practices among all teams, services as a medical home advocate and advisor, leads by example to support a positive work environment and encourages all staff to do the same.
• Participates in establishing protocols, risk management activities, practice performance improvement initiatives and quality measures with interdisciplinary team. Maintains a safety, environmental and infection control in accordance with Brown University Health policies, procedures and objectives.
• Maintains a safe environment for patients, visitors and staff.Performs other related duties as assigned.

MINIMUM QUALIFICATIONS

• Licensure as Registered Nurse in the State of Rhode Island by the Rhode Island Board of Nur