Registered Nurse Care Manager - Clarkston Medical Group

Selectminds; Clarkston (MI); On-site; USD 70,000 - 90,000; Full time

Job summary

McLaren Health Care is seeking a Registered Nurse Care Manager for Clarkston Medical Group to partner with primary care teams in managing chronic and high-risk patients. Responsibilities include comprehensive nursing assessments, care coordination, and ongoing patient education to improve outcomes.

The role emphasizes safe transitions of care, telephonic or in-person engagement based on patient needs, and collaboration with interdisciplinary teams to close gaps in care.

Qualifications

• Current unrestricted Registered Nurse license in the State of Michigan.
• Graduate of an accredited school of nursing.
• Minimum of two years of clinical nursing experience preferred, particularly in primary care, ambulatory care, chronic disease management, care coordination, population health, home health, case management, or a related setting.
• Current BLS certification as required by organizational policy.
• Experience caring for patients with chronic and complex medical conditions strongly preferred.
• Previous care-management, case-management, population-health, or transitional-care experience preferred.

Responsibilities

• Identify, enroll, and manage patients for PDCM, chronic care management, transitional care management, and other care-management services.
• Perform comprehensive nursing assessments to identify clinical needs, barriers to care, health literacy needs, psychosocial concerns, medication issues, and health care utilization patterns.
• Collaborate with patient and care team to develop and monitor an individualized care plan.
• Establish goals with patients and caregivers and provide ongoing coaching and follow-up.
• Serve as a primary contact for patients in care management and communicate changes to providers.

Skills

Clinical nursing experience

Care coordination

Chronic disease management

Home health

Education

Graduated from an accredited school of nursing

RN license in Michigan (unrestricted)

Current BLS certification

Job description

The McLaren system includes 12 hospitals across the state, ambulatory surgery centers, imaging centers, a 730-member employed primary and specialty care physician network, commercial and Medicaid HMOs covering more than 242,000 Michigan lives, home health, infusion and hospice providers, pharmacy services, a clinical laboratory network, and a wholly owned medical malpractice insurance company. McLaren operates Michigan’s largest network of cancer centers and providers, anchored by the Karmanos Cancer Institute, a National Cancer Institute-designated comprehensive cancer center. McLaren has 20,000 full-, part-time and contracted employees and more than 93,000 network providers throughout Michigan.

Registered Nurse Care Manager - Clarkston Medical Group

The Provider-Delivered Care Management (PDCM) Registered Nurse partners with primary care providers, patients, caregivers, and members of the interdisciplinary healthcare team to provide comprehensive care management for patients with chronic, complex, and high-risk health conditions.

The PDCM RN works collaboratively with patients to identify barriers to care, establish individualized goals, improve understanding and management of chronic disease, close gaps in care, and promote adherence to the patient's plan of care. The role focuses on improving clinical outcomes, reducing avoidable emergency department utilization and hospitalizations, facilitating safe transitions of care, and supporting patients in successfully managing their health in the home setting.

The Care Manager serves as a key point of contact between the patient and primary care team and facilitates timely communication of changes in patient condition to the appropriate provider. Care management may be delivered telephonically, electronically, virtually, or in person based on patient need and program requirements.

Essential Duties and Responsibilities

• Identify, assess, enroll, and manage appropriate patients for PDCM, chronic care management, transitional care management, and other care-management services according to organizational requirements.
• Perform comprehensive nursing assessments to identify clinical needs, barriers to care, health literacy needs, psychosocial concerns, medication issues, healthcare utilization patterns, and opportunities for intervention.
• Collaborate with the patient, primary care provider, and interdisciplinary care team to develop, implement, monitor, and update an individualized patient-centered care plan.
• Establish meaningful and measurable goals with patients and caregivers and provide ongoing coaching and follow-up to promote progress toward those goals.
• Serve as a primary point of contact for patients participating in care management, helping facilitate timely communication between patients and their primary care providers when clinical changes or concerns arise.
• Recognize changes in patient condition, identify red-flag symptoms, and elevate concerns promptly to the appropriate provider or level of care in accordance with nursing scope of practice, clinical protocols, and organizational policy.
• Provide patient education regarding appropriate use of the healthcare system, including when symptoms may be managed through the primary care office and when evaluation by urgent care or an emergency department may be indicated.
• Current unrestricted Registered Nurse license in the State of Michigan.
• Graduate of an accredited school of nursing.
• Minimum of two years of clinical nursing experience preferred, particularly in primary care, ambulatory care, chronic disease management, care coordination, population health, home health, case management, or a related setting
• Current BLS certification as required by organizational policy.
• Experience caring for patients with chronic and complex medical conditions strongly preferred.
• Previous care-management, case-management, population-health, or transitional-care experience preferred.

Additional Information

• Schedule: Full-time
• Requisition ID: 26010900
• Daily Work Times: 8:00am-5:00pm
• On Call: No

McLaren Health Care is an Equal Opportunity Employer. Qualified applicants will receive consideration for employment without regard to race, color, religion, sexual orientation, gender identification, age, sex, marital status, national origin, disability, genetic information, height or weight, protected veteran or other classification protected by law.

McLaren Health Care is an Equal Opportunity Employer. Qualified applicants will receive consideration for employmentwithout regard to race, color, religion, sexual orientation, gender identification, age, sex, marital status,national origin, disability, genetic information, height or weight, protected veteran or other classificationprotected by law.