Care Manager (RN) - Regional Hospital Float, System Staffing Office

Dartmouth-Hitchcock Health•Lebanon, NH

About The Position

Care Manager - Regional Float, System Staffing Office Schedule varies, Days including rotation to weekend Regularly scheduled min (1x12 hour shift p/week) One would float to all six D-H system hospitals. In this role you will have exposure to and work in the D-H Lebanon Main Campus, and the member hospitals such as Alice Peck Day in Lebanon NH, Valley Regional in Claremont NH, New London Hospital in New London NH, Mount Ascutney in Vermont, and Cheshire Medical Center in Keene NH. If you have your NH nursing license, Vermont is now a compact state so your license is valid there. Responsibilities Manages and coordinates interdisciplinary care of defined populations through the care continuum from wellness through end of life from a clinical, psychological, social and environmental perspective. Identifies high risk patients requiring on-going coordination of care; performs a comprehensive patient/family assessment, develops a comprehensive treatment plan to include clinical components that will span the continuum of psychosocial issues, implements a plan of care to provide continuing support and coordination for patient/family with multiple complex system needs, manages benefits and negotiates continuing care services for enrollees in various health insurance plans, etc. Utilizes innovative strategies to advocate for patient needs and negotiates complex systems to remove barriers and limitations in accessing health care in all areas including clinical. Monitors the patient’s transition across and within care settings (e.g., home, clinic, skilled nursing facility, rehabilitation, hospital, etc.). Shares assessment and clinical, psychological, social and environmental care plan data with patient/family consent as the patient moves through different care settings. Identifies gaps in the care continuum and work with the community and provider networks to expand access to needed clinical, psychological, social and environmental services. Participates in the development of clinical disease management strategies and identifies the appropriate measures for the evaluation of outcomes. Participates in the development, maintenance, and coordination of an interdisciplinary care delivery system specific to individual patient needs and promotes effective resource utilization. Collects and evaluates clinical and financial data/outcomes, including, but not limited to, patient satisfaction, health and functional status, and resource utilization. Performs other duties as required or assigned.

Requirements

Graduate from an accredited Nursing Program required.
Masters of Science Degree in Nursing (MSN) with 3 years of clinical experience required
Licensed Registered Nurse with New Hampshire eligibility.
Current BLS required

Responsibilities

Manages and coordinates interdisciplinary care of defined populations through the care continuum from wellness through end of life from a clinical, psychological, social and environmental perspective.
Identifies high risk patients requiring on-going coordination of care; performs a comprehensive patient/family assessment, develops a comprehensive treatment plan to include clinical components that will span the continuum of psychosocial issues, implements a plan of care to provide continuing support and coordination for patient/family with multiple complex system needs, manages benefits and negotiates continuing care services for enrollees in various health insurance plans, etc.
Utilizes innovative strategies to advocate for patient needs and negotiates complex systems to remove barriers and limitations in accessing health care in all areas including clinical.
Monitors the patient’s transition across and within care settings (e.g., home, clinic, skilled nursing facility, rehabilitation, hospital, etc.).
Shares assessment and clinical, psychological, social and environmental care plan data with patient/family consent as the patient moves through different care settings.
Identifies gaps in the care continuum and work with the community and provider networks to expand access to needed clinical, psychological, social and environmental services.
Participates in the development of clinical disease management strategies and identifies the appropriate measures for the evaluation of outcomes.
Participates in the development, maintenance, and coordination of an interdisciplinary care delivery system specific to individual patient needs and promotes effective resource utilization.
Collects and evaluates clinical and financial data/outcomes, including, but not limited to, patient satisfaction, health and functional status, and resource utilization.
Performs other duties as required or assigned.