Care Manager - Outpatient (RN) - ICT - Galveston (Casual Appointment)

University of Texas Medical Branch (UTMB)•Galveston, TX

About The Position

To assess, counsel, educate and provide problem solving to assigned patient population. To provide timely and valid information to the interdisciplinary team, physicians and community partners related to the on-going and follow-up care of program specific chronic disease patients. Acts as an advocate for patients and coordinates and collaborates with the medical home to provide quality, cost-effective care and promote positive outcomes for all Integrated Care Team patients.

Requirements

Bachelor’s degree in nursing or related field or equivalent and two years of case management experience or four years related experience.
Registered Nurse (RN)

Nice To Haves

Case Management Certification
Certification in Case Management.

Responsibilities

Screens and/or assesses patient and/or family to determine on-going care needs, identify barriers and solutions to self-management and health care access.
Interacts with each patient at least monthly via telephone or in person contacts.
Participates in activities that improve the quality and efficiency of patient care.
Documents appropriately on all care management activities in the medical record and other departmental databases.
Creates an individualized care plan that addresses the patient’s disease specific educational needs and works with the patient to set self-management goals.
Coordinates patient care throughout enrollment in the program, ensuring that plans are communicated among the medical home practitioners, ancillaries and community partners caring for the patient.
Enrolls patients in a timely manner based on department policy.
Accountable for professional practice, including time management, clinical documentation, statistical and other record-keeping as needed. Reports as required to the appropriate Manager or designee.
Facilitates productivity, team-building, and high team morale in the department.
Attends educational seminars to keep abreast of current knowledge in the field of nursing, chronic disease and/or care management.
Participates in the planning, development, implementation, and evaluation of special projects, programs, and research, as assigned.
Participates in discharge planning as required
Attends staff meetings and participates in departmental problem-solving activities and performance improvement and quality assurance activities.
Consistently communicates and displays oneself in a professional and courteous manner. Demonstrates productive problem-solving techniques and interpersonal relations.
Practices and promotes the principles of patient confidentiality, including adhering to HIPAA guidelines on authorizations and documentation of disclosures of protected health information (PHI).
Adheres to internal controls and reporting structure.
Performs related duties as required.