Care Manager RN

Frederick Health • Frederick, MD

10d

About The Position

The Care Manager RN works collaboratively with medical providers and healthcare professionals within Frederick Health and across the healthcare continuum. The role uses clinical skills to assess patients’ health status, chronic conditions, complex medical issues, unmet social needs, and psychosocial needs; provide information, referrals, and emotional support; and develop plans to manage identified needs in acute or ambulatory settings. Assessment, planning, interventions, and reassessment are performed with a collaborative interdisciplinary team. The Care Manager RN supports patient and family navigation across the healthcare continuum, improves quality outcomes, and promotes appropriate use of resources through effective care management.

Assignments may include integrated care management in ambulatory practices or community practices participating in the Frederick Integrated Healthcare Network, employee health-plan care management, or inpatient care management. Integrated care management uses transitions of care, risk-stratification data, and referrals to guide interventions for attributed beneficiaries and patient populations. The role promotes patient wellness and self-management and may include telephonic, medical-office, and home visits. Employee health-plan work includes coaching employees or spouses with chronic conditions or wellness needs, providing education and resources, and supporting positive health behavior changes. The role may also conduct targeted outreach to close care gaps and develop or lead hospital and community wellness initiatives. Inpatient care management includes screening and assessing patient and family needs, discharge and transition planning, risk stratification, psychosocial assessment, and individualized planning across the continuum of care.

The position requires a current Maryland Registered Nurse license, a Bachelor of Nursing degree from an accredited school, three to five years of care management and/or healthcare experience, and current CPR certification. Care Management certification is preferred. Patient-contact knowledge and skills must be maintained for patients of all ages, from neonates through geriatric patients. The role involves light physical work, including occasional lifting up to 20 pounds and walking or standing for a significant portion of the day. Bloodborne pathogen exposure is classified as Category B, meaning exposure to blood or body fluids may occur.

Requirements

• Current license as a Registered Nurse in the state of Maryland.
• Bachelor of Nursing degree from an accredited school of nursing.
• Three to five years of care management and/or healthcare experience.
• Current certification in Cardiopulmonary Resuscitation (CPR).
• Effective interpersonal and communication skills, including strong customer service skills.
• Strong organizational and time-management skills.
• Critical-thinking ability and the ability to apply creative problem-solving to complex situations.
• Ability to work in a fast-paced team environment, multitask, adapt to change, and take on new challenges or projects.
• Ability to communicate and collaborate effectively with physicians and staff.
• Knowledge of disease management, psychosocial aspects of patient care, and community resources.
• Ability to work independently and interdependently.
• Credibility and ability to advocate for patients while remaining committed to health-system goals.
• Skills in planning, organizing, and managing multiple functions and complex processes.
• Knowledge of basic computer software programs.
• Must maintain current knowledge and skills for appropriate patient care and contact across all age groups: neonate, infant, child, adolescent, adult, and geriatric.

Nice To Haves

• Care Management certification, including but not limited to Accredited Case Manager (ACM) certification.

Responsibilities

• Deliver care coordination at Frederick Health, which may include hospital or ambulatory site assignments.
• Perform individualized assessments and develop plans of care to address identified needs.
• Identify barriers to care, including disease-education needs, socioeconomic status, unmet social needs, impaired coping, and support-network dysfunction.
• Communicate with interdisciplinary care teams, patients, and families, and promote coordination among healthcare professionals.
• Monitor and evaluate care-management plans.
• Provide education regarding health conditions and symptom management.
• Apply knowledge of regulatory requirements relevant to the assigned healthcare setting.
• Support patient and family navigation across the healthcare continuum and promote quality outcomes and appropriate resource utilization.
• Interpret data to evaluate and implement care-management strategies and interventions for attributed beneficiaries and patient populations.
• Promote patient wellness and self-management strategies.
• Provide care management and coaching, including information, education, resources, problem-solving support, and goal-setting.
• Conduct targeted outreach to help close identified care gaps, such as mammograms, colonoscopies, and well-care visits.
• Screen and assess inpatient needs related to care coordination, discharge and transition planning, risk stratification, and psychosocial support.
• Develop individualized plans that support patient progress across the continuum and optimize quality of care, patient satisfaction, utilization, and reimbursement.
• Promote diversity and inclusive working relationships.

Benefits

• Health, dental, and vision insurance, available on the first of the month after 30 days of employment for employees hired to work at least 20 hours per week.
• Life insurance for eligible employees, paid by the employer.
• Short-Term Income Replacement and Long-Term Disability for eligible employees, paid by the employer.
• Paid Time Off program for eligible employees.
• 403B retirement plan with an employer match for eligible employees.
• Free financial planning sessions for all employees.
• Educational assistance program.
• Employer-paid Employee Assistance Program.

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level