RN Care Manager Case Management

UNC Health; Eden (NC); On-site; USD 64,000 - 93,000; Full time

Job summary

UNC Health is seeking a Care Manager RN to coordinate comprehensive, patient-centered care for individuals in Eden, NC. The role emphasizes risk segmentation, assessments, and tailored care plans within a multidisciplinary team.

Responsibilities include managing care transitions, payer communication, and ongoing patient support across the healthcare journey, with an emphasis on evidence-based practice and quality improvement. This is a 20-hour-per-week, onsite per diem position.

Qualifications

• Graduation from a state accredited school of professional nursing.
• RN license valid in North Carolina.
• Minimum 2 years of RN experience.

Responsibilities

• Conduct RN care manager assessments using standardized tools.
• Develop individualized, evidence-based care plans.
• Coordinate care transitions across settings with the care team.
• Collaborate with payers and providers to optimize care and approvals.
• Support quality improvement initiatives and accurate documentation.

Skills

Risk segmentation

Patient assessments

Care planning

Payer communication

Care transitions

EHR proficiency

Team collaboration

Education

State accredited nursing school

BSN preferred or enrolled

Tools

EHR systems

Billing/coding software

Job description

Your passion belongs at UNC Health. Join more than 56,000 teammates working together to improve the health and well-being of the communities we serve across North Carolina.

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

• Patient Assessments: Conduct comprehensive care manager assessments utilizing standardized assessment tools and nursing knowledge to evaluate patients' functional abilities, cognitive status, and psychosocial support systems.
• Identify any barriers to care and develop appropriate interventions to address them.
• Patient-Centered Care Plans: Collaborate with providers, patients, their families, and the healthcare team on individualized care plans that align with patients' goals, preferences, and values.
• Ensure that care plans are evidence-based, culturally sensitive, and promote patient engagement and self-management.
• Risk Segmentation: 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.
• Develop strategies to effectively manage and mitigate risks for patients, ensuring their overall well-being and optimal health outcomes.
• Tasks or Interventions: Coordinate and facilitate necessary tasks or interventions to support patients' care plans; collaborate with healthcare providers, community resources, and support services to ensure seamless coordination of care; advocate for patients' needs and rights, ensuring that they receive appropriate and timely interventions; participate in quality improvement initiatives to ensure patient, departmental, and organizational goals/outcomes are met or exceeded.
• Care Transitions: Coordinate and facilitate care across various healthcare settings, ensuring seamless transitions and continuity of care; communicate and collaborate with healthcare providers, specialists, and community resources; facilitate multidisciplinary care team meetings to discuss patients' care plans and progress.
• Coordinated Work: 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.
• Payer Communication: Collaborate with payers, insurance companies, and utilization management teams to optimize reimbursement and facilitate timely approvals for necessary care and services; accurately document and bill for services rendered, as applicable, in compliance with insurance and regulatory requirements; collaborate with billing and coding professionals to ensure compliance with coding and documentation requirements.
• Longitudinal Care as part of the Medical Home (varies per patient population and care setting): Act as a key point of contact and advocate for patients within the care team; provide ongoing support and care coordination throughout the patient's healthcare journey, ensuring continuity and comprehensiveness of care.

Education Requirements

• Graduation from a state accredited school of professional nursing.
• Magnet hospitals: BSN required or must be enrolled in an accredited program within 4 years of employment and obtain a bachelor's degree with a major in nursing or a master's degree with a major in nursing within 7 years of employment date.

Licensure/Certification Requirements

• Registered Nurse with a valid license to practice in North Carolina.

Professional Experience Requirements

• Minimum of 2 years of experience as a registered nurse.

Knowledge, Skills, and Abilities Requirements

• Strong knowledge of risk segmentation, patient assessments, patient-centered care planning, care transitions, and payer communication.
• Excellent communication, collaboration, and problem-solving skills.
• Ability to work independently and as part of a multidisciplinary team.
• Proficiency in electronic health records (EHR) and other relevant software applications.

Job Details

Legal Employer: NCHEALTH

Entity: UNC Rockingham Health Care

Organization Unit: RHC Case Management

Work Type: Per Diem

Standard Hours Per Week: 20.00

Salary Range: $31.04 - $44.62 per hour (Hiring Range)

Pay offers are determined by experience and internal equity

Work Assignment Type: Onsite

Work Schedule: Variable

Location of Job: US:NC:Eden

Exempt From Overtime: Exempt: Yes

This position is employed by NC Health (Rex Healthcare, Inc., d/b/a NC Health), a private, fully-owned subsidiary of UNC Health Care System. This is not a State employed position.

Qualified applicants will be considered without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, age, genetic information, disability, status as a protected veteran or political affiliation.

UNC Health makes reasonable accommodations for applicants' and employees' religious practices and beliefs, as well as applicants and employees with disabilities. All interested applicants are invited to apply for career opportunities. Please email [e-mail] if you need a reasonable accommodation to search and/or to apply for a career opportunity.