Registered Nurse, Care Manager - Enhanced Care Management

Neighborhood Healthcare•Temecula, CA

3d•Hybrid

About The Position

The RN Care Manager supports Enhanced Care Management (ECM) patients with complex medical conditions and completes medication reconciliation with pharmacies for all ECM-enrolled patients. The role provides care coordination and connects patients with services and social support, including appointment scheduling and referral management. It also requires travel to Neighborhood Healthcare sites for designated meetings and trainings. This is a hybrid position, with on-site expectations dependent on performance. The role manages a caseload of patients with complex medical needs, supports patient activation toward health goals, tracks medical and behavioral health outcomes, provides education, coordinates care with providers and hospitals, and maintains timely documentation and required assessments. Pediatric RN Care Manager duties include helping individuals and families access basic needs and providing one-on-one counseling to high-risk pediatric and adult patients. The position requires an associate’s degree in nursing, a California Registered Nurse license, current AHA-approved Basic Life Support certification, a valid driver’s license, and proof of auto insurance. Three years of experience in nursing or case management and experience working with community outreach, behavioral health, high-risk populations, and/or pediatric populations are required. The posted pay range is $45.9135 to $67.93 per hour, depending on experience. The role is eligible for a $2,500 signing bonus.

Requirements

Associate’s degree in nursing required.
California Registered Nurse license required.
Current Basic Life Support (BLS) certification through an American Heart Association-approved source is required upon hire and must be maintained as a condition of employment; the course must include an in-person, hands-on skills check with a certified instructor.
Valid California driver’s license, or an out-of-state driver’s license for active military personnel or spouses, required.
Proof of auto insurance required.
Three years of experience in nursing or case management required.
Experience with community outreach, behavioral health, and working with high-risk and/or pediatric populations required.
Excellent verbal and written communication skills, including composition, typing, and proofreading.
Ability to work with Microsoft applications such as Excel and Word.
Ability to interpret instructions in written, oral, diagram, or schedule form.
Ability to interact effectively with clinic personnel, patients, and community-based organizations.
Knowledge of and experience with social and health issues.
Knowledge of and experience with evidence-based communication such as Motivational Interviewing or similar empathy-based communication strategies.
Excellent interpersonal and conflict-resolution skills.
Ability to engage patients and providers by phone and in person.
Sensitivity to multicultural communities, mental health conditions, and addictive disorders.
Awareness of the impact of unmitigated bias and judgment on health, and commitment to addressing both.
Ability to manage multiple tasks simultaneously.
Excellent planning and organizational ability.
Ability to work as part of a team and independently.
Ability to handle highly confidential information professionally and ethically.
Ability to lift or carry 25 pounds and stand for long periods.
Follow safety procedures in Neighborhood Healthcare’s Illness and Injury Prevention Plan, use appropriate body mechanics, and follow infection-control and blood-borne pathogen protocols.
Maintain patient, employee, and volunteer privacy and access information only on a need-to-know basis for business purposes.
Comply with regulations regarding corporate integrity and security obligations.

Nice To Haves

Bachelor’s degree in nursing preferred.
Two years of clinical, outpatient, or general medicine experience preferred.
Bilingual English/Spanish preferred.

Responsibilities

Manage a caseload of patients with complex medical needs.
Engage, support, and encourage patient activation toward achieving health goals.
Track medical and behavioral health outcomes in the web-based care management platform and patient electronic health information platform.
Improve health literacy by providing chronic medical and behavioral health education to patients and families.
Prioritize patient cases for systematic population and caseload review by gathering input from ECM team members.
Facilitate communication between patients and providers by identifying health and wellness goals to incorporate into health action and shared care plans.
Coordinate physical care management and care coordination relationships with external healthcare providers.
Receive, identify, and follow up on treatment and medication alerts.
Consult with ECM team members about clinical concerns and questions.
Coordinate patient admissions and discharges with hospitals to ensure smooth transitions of care.
Conduct medication reconciliations with input from providers.
Track and ensure required assessments and screenings are performed, including comprehensive health assessments and shared care plans.
Review adult comprehensive health assessments completed by other care team members.
Participate in quality improvement activities.
Document patient care coordination, education, and other services in ECW.
Prioritize activities according to intensity, need, and required follow-up.
Provide accurate and timely reports to management as needed.
For Pediatric RN Care Manager duties: help individuals and families improve quality of life by ensuring access to basic needs such as medical care, food, behavioral health, and safety.
For Pediatric RN Care Manager duties: conduct one-on-one counseling with high-risk pediatric and adult patients.
Travel to Neighborhood Healthcare sites for designated meetings and trainings.
Follow safety procedures, report injuries and unsafe conditions, use appropriate body mechanics, and follow infection-control procedures.
Protect confidential patient, employee, and volunteer information and comply with corporate integrity and security requirements.
Report unethical, fraudulent, or unlawful behavior or activity.