Community RN Care Manager

Care N Care Insurance Company of North Carolina•Greensboro, NC

About The Position

The Community RN Care Manager manages high-risk members with chronic illness to promote effective education, self-management support, and timely healthcare delivery, achieving optimal quality and financial outcomes. The Community RN Care Manager will formulate and implement a care management plan that addresses the member's identified needs by assessing issues, resources, and care goals. The Community RN Care Manager will advocate for the member and support the member in navigating the health care system. Additionally, the Community RN Care Manager will collaborate with the interdisciplinary team and members PCP / Health Care Team to identify and support achieving the member's short-term and long-term health goals. HTA’s Care Management model is to provide longitudinal care management for identified members. A vital goal of the Community RN Care Manager within the longitudinal care management framework is to manage the post-acute care of identified members to avoid and limit poor health outcomes, frequent emergency room visits, and hospital readmissions. Based on the RN’s work experience in nursing and knowledge of the health care system, the aims are to provide members with education and resources to reduce preventable emergency room visits, hospitalizations, and readmissions.

Requirements

Associate Degree in Nursing Required
Five years combined of nursing-related care experience and/ or home care experience.
Candidate needs to be local and be able to travel to local facilities as needed for this position.
Registered Nurse licensed in North Carolina or a Compact state.
Current NC RN licensure in good standing
Valid NC driver’s license
Annual Flu Vaccine
Knowledge of care management concepts along the continuum
Knowledge of Medicare benefits
Experience and ability to use Microsoft Office products and word-processing software daily.
Must be able to drive to local healthcare facilities to meet with members/providers as needed.
Excellent written, verbal, and listening communication abilities.
Communicate clearly and appropriately with members, coworkers, and providers.
Ability to manage conflict, stress, and multiple simultaneous work demands effectively and professionally.
Ability to successfully articulate the process of attaining goals and outcomes of care management.
Ability to apply clinical knowledge and experience in a care management role.
Ability to engage and collaborate with the member and significant others in the care management process.
Ability to care manage diverse populations without applying one’s values.
Ability to work with minimal supervision within the nursing scope of practice.
Ability to think critically and analytically, and work with minimal supervision.
Ability to evaluate and appropriately respond to verbal and non-verbal communication from patients in diverse stages of development.
Ability to use good judgment to protect personal safety while performing duties.

Nice To Haves

BSN or Advanced Degree in Nursing
Case Management Certification is desirable.
Case Management, Care Management, Telephonic Case Management, and/or Disease Management experience

Responsibilities

Collaborates with providers and practice staff in identifying appropriate members for care management, utilizing established Care Management criteria.
Performs initial and periodic holistic assessments for identified care-managed populations. This includes physical and psychosocial concerns for members as appropriate. The assessment consists of a systematic and pertinent data collection about the member's health status.
Prioritizes members according to intensity, need, and required follow-up.
Perform in-person visits with identified high-risk, high-utilizer members in the home or facility settings to assess SDOH and transitional care needs.
Formulate and implement a care management plan that addresses the member’s identified needs by assessing the member/family needs, issues, resources, and care goals; determining the choices available to individual members; and educating the patient/family on the choices available to meet their goals.
Implements a care management plan mutually agreed upon by the health care team and the member/representative.
Plans specific mutual self-management goals, objectives, and action-oriented interventions with the members.
Evaluate the effectiveness of the care plan in meeting established care goals; revise the plan as needed to reflect changing needs, issues, and goals.
Monitor and evaluate the member's progress at prescribed minimal intervals.
Collaborates with the healthcare team to revise the care management plan when changes occur.
Initiates/participates in care conferences to discuss multidisciplinary team responsibilities, member progress, and new problems.
Identifies and effectively utilizes community resources to meet the SDOH needs of members/families.
Facilitates members' access to community resources, as appropriate, in collaboration with Social Work.
Promotes member self-management and empowers members/families to achieve maximum wellness and independence.
Interacts professionally with members/families and involves them in the formation of a plan of care.
Performs transitional follow-up calls for members recently discharged from acute hospitalizations, with particular emphasis on those members who are at high risk for readmission.
Performs in-person transitional care visits as directed for SDOH and needs assessment.
Collaborates with providers and other healthcare team members, including inpatient facilities, outpatient providers, and the Utilization Management department, to initiate transitions of care and facilitate care across the healthcare continuum, and optimize clinical and financial outcomes.
Determines and completes appropriate referrals to internal and external associates.
Serves as a liaison to providers, members, and families to coordinate services.
Participate in weekend rotation for member transitional care needs.
Maintains accurate and timely documentation.
Ensures documentation meets current standards and policies.
Strives to meet established standards for productivity.
Participates in regular team meetings and peer review activities.
Participates in departmental and organizational committees, as applicable.
Assists/supports in the orientation of new personnel.
Promotes collaborative teamwork.
Meets regularly with the care management team to provide member updates, identify issues, and develop resolution strategies.
Performs all duties and responsibilities according to the Nurse Practice Act and the basic principles and guidelines of professional nursing.
Maintains appropriate professional boundaries with members, families, coworkers, and community providers.
Maintains a working knowledge of and adheres to applicable federal and state regulations, including, but not limited to, laws related to patient confidentiality, release of information, and HIPAA.
Interacts harmoniously and effectively with others, focusing on attaining organizational goals and objectives through teamwork.
Conforms to acceptable attendance and punctuality standards in the HTA Employee Handbook.
Abides by the organization’s compliance program and requirements.
Current on all required training for the current year.
Other duties as assigned.