Outpatient Care Management RN

About the position

The OP Care Management RN provides care management and population health services to patients, primarily targeting those with high vulnerability during transitions between care settings. This role involves coordinating care for patients with chronic diseases, facilitating medication management, and managing care transitions across the continuum. The OP Care Management RN will create personalized care plans for each patient, promoting effective partnerships among patients, families, nurses, physicians, and other healthcare disciplines. A data-driven approach will be utilized to manage patient populations, improve access to care, and achieve optimal clinical outcomes. This position is hybrid, requiring 1 day remote work and 4 days in the office, covering the Carle Health Curtis Clinic.

Responsibilities

• Communication and coordination between care settings across the healthcare continuum
• Identifies appropriate providers, healthcare organizations, and community services throughout the continuum of care
• Communicates with an interdisciplinary team to develop and maintain positive working relationships with patients, families, and all other members of the care team
• Provides education on medication adherence, follow-up appointments, and other activities to maximize patient knowledge of self-care and reduce avoidable readmissions
• Empowers patients and families through education and a trusting relationship to utilize healthcare resources appropriately
• Conducts holistic health care assessments including health risk assessments, patient preferences and goals, health literacy, patient engagement level, and social determinants of health
• Ensures accurate documentation of clinical, financial, and other information using appropriate systems
• Utilizes data, dashboards, or other reporting mechanisms to support high reliability performance and outcome evaluation
• Functions as an arm of the primary care provider to support care coordination and chronic disease education for patients
• Documents within patient Electronic Medical Record (EMR) to support departmental specific workflows
• Effectively communicates with patients and all cross-continuum care team members to achieve optimal patient outcomes

Requirements

• License/Certifications: Certified Case Manager within 2 years - Commission for Case Manager Certification (CCMC)
• Education: College Diploma in Nursing (Required)

Benefits

• $5,000 sign-on bonus
• $5,000 relocation for greater than 100 miles
• $2,500 relocation for greater than 50 miles
• Comprehensive benefits package including health insurance, retirement plans, and more