RN Care Manager

P3 Health Partners•Salem, OR

17d

About The Position

People. Passion. Purpose. P3 Health Partners is a population health management group founded and led by fellow physicians who want to shift the industry’s focus from managing illness to cultivating wellness. We are health plan agnostic and work with most plans in our markets. As the conduit between you and the health plan, we want to make a difference where it counts - with your patients, their families, and the communities where we live. The mission of P3 is simple. We want to help providers and their patients embrace a new kind of care. A kind of care that gives patients the tools and resources they need to manage their long-term health and wellness. Overall Purpose Are you a compassionate mission-driven nurse looking to make a meaningful impact on the lives of complex medical patients? As a nurse care manager at P3 Health Partners, you’ll bring hope and healing to patients with complex medical needs. In this full-time role, you’ll be a vital member of an interdisciplinary team, transforming lives and empowering primary care physicians to deliver exceptional care to those who need it most. The scope of practice includes, but is not limited to, providing case management to patients with complex medical conditions at high risk for hospitalization or worsening medical condition. You will interact with patients in the clinic setting, through telephonic or telehealth contact. You will attend and contribute to interdisciplinary team meetings. You will cover all counties within the state for which you are hired.

Requirements

Active and unencumbered nurse in the state you will practice
Active case management certification
Minimum 1 year of case management experience, preferably geriatric medicine
Strong clinical judgment, problem -solving and critical thinking skills required
Excellent communication skills with patients, providers, internal and external customers required
Must have excellent organizational skills and ability to work independently, with minimal supervision
Flexible, self-driven and innovative personality
Minimum two years of clinical nursing experience, care management, and/or experience with a managed care/HMO organization, required.
Ability to obtain and maintain current Registered Nurse licenses in the states where P3 health partners operates
Case Management or within 1 year of hire
Travel between counties where P3 Health Partners is located in the state hired is required.

Nice To Haves

Discharge planning experience preferred
Understanding of utilization management preferred
Understanding of HEDIS measures preferred
Graduate from an accredited school of nursing
Education: Bachelor’s degree in nursing preferred

Responsibilities

Responsible for comprehensive patient assessments through medical records, clinician and patient interviews, telephonic and / or face to face.
Have close follow-up with all patients amending care plans as necessary with each patient contact
Educate patients, their families and/or caregivers.
Assist patients, families or caregivers’ education and support advanced care planning to include palliative care, and/or hospice care as appropriate.
Communicates with the comprehensive care team and primary care physician regarding individualized care plans and patient’s progress.
Identifies patient care needs and barriers to care.
Develops and implements plans to mitigate barriers to patient self-management or self-care.
Prepares documentation according to P3 health partners workflows and policy.
Works with patients, families and caregivers to promote self- management and meet care plan goals
Build relationships with PCPs, internal and external customers.
Communicate opportunities to advance clinical models.
Confidently use associated technology and computers.
Ensure patient privacy and adherence to all HIPAA regulations and standards for handling PHI.
Participate in quality improvement initiatives, documentation audits, and other activities that support clinical excellence and operational efficiency.
Maintain compliance with required training, timely chart closures, meeting attendance and other requirements.
Serve as a positive and collaborative team member.
Role model the P3 Health Partners core values.
Other patient care projects as assigned.