RN Case Manager - Truman Health Services

UNM Medical Group•Albuquerque, NM

1d•Onsite

About The Position

Provides Registered Nurse case management designed to improve individual and/or family quality of life to a specified client group and their families. Coordinates comprehensive health care and community-based services, home visits, and assessments. Develops, implements, coordinates, and evaluates health care plans in an outpatient environment; collaborates with other health care providers, community service agencies, and schools to coordinate care. About Truman Health Services: Compassionate & Evidence-Based Treatments : Join an interdisciplinary team that provides patient centered medical care for HIV and gender-affirming primary care. We also provide consult services for Hep-C and PrEP and strive to ensure the highest standards in health care. Holistic & Integrated Approach : Be part of an organization that takes a comprehensive approach, addressing patients' medical, social, and mental health needs with a commitment to their overall well-being. Inclusive & Impactful: With locations in both Albuquerque and Roswell, NM, contribute to a dynamic, LGBTQIA+ affirming environment where you can make a real difference in the lives of New Mexicans. UNM Medical Group, Inc. welcomes people with lived experience to apply.

Requirements

Associate's Degree in Nursing with at least 2 years of work experience that can be demonstrated to be applicable to the duties and responsibilities specified; including experience in case management and/or working with chronically ill patients.
State of New Mexico Licensed Registered Nurse or licensure pending as documented by temporary licensure OR current RN licensure from a state participating in the "multistate privilege to practice" compact with New Mexico.
Completed degree from an accredited institution that are above the minimum education requirement may be substituted for experience on a year for year basis.

Nice To Haves

Experienced providing nursing and/or case management services to medically and socially complex populations.
Experienced working with the LGBTQ+ community.
Experienced working in a community based multi-disciplinary setting.
Bilingual English/Spanish.

Responsibilities

Coordinate care and treatment of patients as required for a multidisciplinary, patient centered care team approach.
Adhere to and promote the core expectations of the Patient Centered Medical Home.
Identify patients requiring patient case management interventions by utilizing clinic data base and chart review, screenings and referral tracking.
Review patient information/reports in collaboration with health care team and social case managers.
Facilitate and/or participate in conferences providing ongoing evaluation of interdisciplinary dynamics, goals attainment and treatment management.
Maintain computer-based tracking system and compile reports and records.
Develop comprehensive collaborative plan of care in collaboration with physicians, RNs and other health care team members and update bi-annually.
Coordinate the continuity of patient care throughout all health care settings; promote effective communication among public health agencies, UNMH, patients and health care providers.
Coordinate continuity of patient care upon patients' discharge from hospital including development of care plans and document appropriately.
Assist in initial assessment of patients, perform patient triage and arrange necessary consents, to include the coordination of discharge or follow-up care.
Request laboratory and radiology diagnostics; initiate blood work, blood cultures, transfusions and IVs; distribute specimens; follow-up on diagnostic results; provide direct patient care; record all patient care activities in chart and/or data base.
Conduct nurse intakes for all new patients to the clinic.
Visit patients in the hospital or other healthcare facilities to ensure linkage to and continuity of care.
Participate in home visits as needed with other members of the healthcare team to assist in ensuring patients are retained in care.
Conduct nurse visits to include patient assessment, wound care, medication administration, patient education and other duties within the scope and practice of a RN.
Manage provider patient panels and proactively track patient�s needs to ensure they receive care to optimize health.
Conduct telephone and in-person triage of patients with acute care needs and collaborate with providers.
Assume relief charge duties, when designated.
Administer IV fluid and injectable medications, assist with procedures, provide wound care and document all nursing care.
Assist with or institute emergency measures for sudden, adverse developments in patients.