Care Manager, Outpatient - Clear Lake Center

Minimum Qualifications:  

• Bachelor’s degree in nursing or related field or equivalent and two years of case management experience or four years related experience.

• Registered Nurse (RN)

   

   

Job Summary:

To assess, counsel, educate and provide problem solving to assigned patient population. To provide timely and valid information to the interdisciplinary team, physicians and community partners related to the on-going and follow-up care of program specific chronic disease patients. Acts as an advocate for patients and coordinates and collaborates with the medical home to provide quality, cost-effective care and promote positive outcomes for all Integrated Care Team patients.

Job Duties:

• Screens and/or assesses patient and/or family to determine on-going care needs, identify barriers and solutions to self-management and health care access. 

• Interacts with each patient at least monthly via telephone or in person contacts. 

• Participates in activities that improve the quality and efficiency of patient care. 

• Documents appropriately on all care management activities in the medical record and other departmental databases. 

• Creates an individualized care plan that addresses the patient’s disease specific educational needs and works with the patient to set self-management goals. 

• Coordinates patient care throughout enrollment in the program, ensuring that plans are communicated among the medical home practitioners, ancillaries and community partners caring for the patient. 

• Enrolls patients in a timely manner based on department policy. 

• Accountable for professional practice, including time management, clinical documentation, statistical and other record-keeping as needed. Reports as required to the appropriate Manager or designee. 

• Facilitates productivity, team-building, and high team morale in the department. 

• Attends educational seminars to keep abreast of current knowledge in the field of nursing, chronic disease and/or care management. 

• Participates in the planning, development, implementation, and evaluation of special projects, programs, and research, as assigned. 

• Participates in discharge planning as required. 

• Attends staff meetings and participates in departmental problem-solving activities and performance improvement and quality assurance activities. 

• Consistently communicates and displays oneself in a professional and courteous manner. Demonstrates productive problem-solving techniques and interpersonal relations. 

• Practices and promotes the principles of patient confidentiality, including adhering to HIPAA guidelines on authorizations and documentation of disclosures of protected health information (PHI). 

• Adheres to internal controls and reporting structure.

Salary Range:  Actual salary commensurate with experience.

Work Schedule:

On-site at Clear Lake Center, Monday through Friday, 8am to 5pm, and as needed on occasion. Remote opportunities available.