- Perform comprehensive assessment of patients health needs, including health status and behaviors, level of function, psychosocial situation, and available support systems and determines potential needs.
- Establish care plans in collaboration with the primary care physician and the patient care team.
- Provide health education.
- Identify patients at risk for proactive intervention.
- Pull and manipulate data to identify risk patients and present information to the care team.
- Refer patients to a variety of resources including, but not limited to: nutrition, social work, rehabilitation, behavioral specialist, diabetes education, Healthy Living Workshop, etc.
- Contact patients who utilize ED or have been hospitalized after discharge to determine the reason for the ED visit or hospitalization and work with patient to develop a plan to avoid those facilities.
- Coordinate care for complex cases or those patients seeing multiple specialists.
- Maintain uptodate and accurate documentation of patient assessment and plan provided to the patient to ensure the effective integration of information for use by the health care team to ensure ongoing and continued quality of care, in accordance with evidencebased practice.
- Analyze patient care trends and actively seek out and collaborate with the care team to improve overall quality and efficiency of care.
- Use registry data to identify problems or gaps in services and initiate intervention.
- Participate and lead patient care conferences.
- Manage patient panel with physician office staff to identify appropriate patients and measure outcomes.
- Collaborate with physicians and office staff.
- Proactively advocate for patient care issues to ensure that overall quality and type of care is sensitive to each specific patient/familys needs.
- Participate in committees and activities related to the development of Medical Home, Accountable Care Organization (ACO), and other insurance carriers.
- Bachelors Degree (BS/BA/BSN)
- Prior experience in care coordination in a community setting or primary care practice
- Program development, operations management, and/or supervisory experience
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Case Manager RN Bilingual - Grand Junction, CO, United States - Intermountain Healthcare
Description
The Nurse Care Manager works collaboratively with physicians and other members of the health care team to improve the health of patients with chronic conditions or complex needs.
This position educates patients and families to help them manage their health care needs.The incumbent facilitates communication, coordinates services, addresses barriers, and promotes optimal allocation of resources while balancing clinical quality and cost management.
As an RN Care Manager, you need to know how to:Ongoing need for employee to see and read information, labels, assess patient needs, operate monitors, identify equipment and supplies.- and -Frequent interactions with patient care providers, patients, and visitors that require employee to verbally communicate as well as hear and understand spoken information, alarms, needs, and issues quickly and accurately, particularly during emergency situations.- and -Manual dexterity of hands and fingers to manipulate complex and delicate equipment with precision and accuracy.
This includes frequent computer use and typing for documenting patient care, accessing needed information, medication preparation, etc.- Will also bend to retrieve, lift, and carry supplies and equipment.
and -Need to walk and assist with transporting/ambulating patients and obtaining and distributing supplies and equipment. This includes pushing/pulling gurneys and portable equipment, including heavy items. Often required to navigate crowded and busy rooms (full of equipment, power cords on the floor, etc).- Marys Regional HospitalThe hourly range for this position is listed below. Actual hourly rate dependent upon experience.
$We care about your well-being – mind, body, and spirit – which is why we provide our caregivers a generous benefits package that covers a wide range of programs to foster a sustainable culture of wellness that encompasses living healthy, happy, secure, connected, and engaged.
and our commitment to diversity, equity, and inclusion .
Intermountain Health is an equal opportunity employer.
Qualified applicants will receive consideration for employment without regard to race, color, religion, age, sex, sexual orientation, gender identity, national origin, disability or protected veteran status.
