RN Care Manager

UNC REX Healthcare; Mebane (NC); On-site; USD 70,000 - 90,000; Full time

Job summary

UNC Health is seeking an experienced Care Manager RN to support two primary care clinics in Chapel Hill and Mebane. The role focuses on coordinating comprehensive patient care, conducting risk assessments, and developing patient-centered care plans within the medical home.

You will collaborate with providers, patients, and families to ensure evidence-based, culturally sensitive care, coordinate transitions across settings, support payer communications, and participate in quality improvement to

Qualifications

• Graduation from a state accredited school of professional nursing.

Responsibilities

• Patient Assessments: conduct comprehensive assessments and identify barriers to care.
• Patient-Centered Care Plans: develop individualized, evidence-based care plans.
• Risk Segmentation: assess risk levels using standardized tools and clinical judgment.
• Tasks or Interventions: coordinate and facilitate necessary interventions.
• Care Transitions: coordinate care across settings and ensure continuity.
• Coordinated Work: collaborate with the healthcare team for accountability.
• Payer Communication: optimize reimbursement and obtain timely approvals.
• Documentation and Billing: accurately document and bill for services rendered.
• Longitudinal Care: provide ongoing support and advocacy within the care team.

Skills

Care management

Patient assessments

Care planning

Care coordination

Payer communication

Documentation and billing

Quality improvement

Collaboration

Education

Graduation from a state accredited school of professional nursing

Job description

Description

Become part of an inclusive organization with over 40,000 teammates, whose mission is to improve the health and well-being of the unique communities we serve.

*This position will be assigned to support two primary care clinics, one in Chapel Hill and the other in Mebane.

Summary:
The Care Manager RN plays a crucial role in providing comprehensive and coordinated care to patients within UNC Health. This position involves utilizing a variety of skills, including risk segmentation, patient assessments, patient-centered care plans, tasks or interventions, care transitions, delegated work, and payer communication. The Care Manager works collaboratively with healthcare providers, patients, and their families to ensure that patients receive the highest quality of care and support throughout their healthcare journey.

Responsibilities:
1. Patient Assessments:
a. Conduct comprehensive care manager assessments utilizing standardized assessment tools and nursing knowledge to evaluate patients' functional abilities, cognitive status, and psychosocial support systems.
b. Identify any barriers to care and develop appropriate interventions to address them.
2. Patient-Centered Care Plans:
a. Collaborate with providers, patients, their families, and the healthcare team on individualized care plans that align with patients' goals, preferences, and values.
b. Ensure that care plans are evidence-based, culturally sensitive, and promote patient engagement and self-management.
3. Risk Segmentation:
a. Utilize standardized tools and clinical judgment to identify and assess the risk level of patients based on various factors such as medical conditions, social determinants of health, and behavioral health needs.
b. Develop strategies to effectively manage and mitigate risks for patients, ensuring their overall well-being and optimal health outcomes.
4. Tasks or Interventions: a. Coordinate and facilitate necessary tasks or interventions to support patients' care plans.
b. Collaborate with healthcare providers, community resources, and support services to ensure seamless coordination of care.
c. Advocate for patients' needs and rights, ensuring that they receive appropriate and timely interventions. d. Participates in quality improvement initiatives to ensure patient, departmental, and organizational goals/outcomes are met or exceeded.
5. Care Transitions: a. Coordinate and facilitate care across various healthcare settings, ensuring seamless transitions and continuity of care.
b. Communicate and collaborate with healthcare providers, specialists, and community resources to ensure comprehensive and coordinated care delivery.
c. Facilitate multidisciplinary care team meetings to discuss patients' care plans and progress.
6. Coordinated Work:
a. Coordinate care management tasks with other members of the healthcare team while maintaining accountability for the overall coordination and management of patients' care as applicable per patient population.
7. Payer Communication:
a. Collaborate with payers, insurance companies, and utilization management teams to optimize reimbursement and facilitate timely approvals for necessary care and services.
8. Accurately document and bill for services rendered, as applicable, in compliance with insurance and regulatory requirements.
a. Collaborate with billing and coding professionals, as applicable, to ensure compliance with coding and documentation requirements.
9. Longitudinal Care as part of the Medical Home (varies per patient population and care setting):
a. Act as a key point of contact and advocate for patients within the care team.
b. Provide ongoing support and care coordination throughout the patient's healthcare journey, ensuring continuity and comprehensiveness of care.

Other Information

Other information:

Education Requirements

• Graduation from a state accredited school of professional nursing