About the role

  • RN Care Manager managing high risk and chronic illness at NorthLakes Community Clinic. Focused on integrated, quality care and patient engagement within the clinic setting.

Responsibilities

  • Manage high risk and chronic illness to promote whole-person, integrated, quality care
  • Conduct in-office patient visits as outlined in care plan
  • Create and promote engagement with a care plan, developed with the patient, primary care provider and/or specialty care provider and family/caregiver(s)
  • Support the delivery of integrated, whole-person care in family medicine, recovery and psychiatric care
  • Engage patients in self-management and shared decision-making
  • Increase utilization of preventative care services
  • Promote timely access to appropriate care to reduce emergency room utilization and hospital readmissions
  • Increase continuity of care by managing relationships with tertiary care providers, transitions-in-care, and referrals
  • Work with internal providers on coordinating schedules, getting a client in to other service lines as needed
  • Facilitate patient access to appropriate medical and specialty providers
  • Assist with the identification of “high-risk” patients with a chronic illness and coordinate care
  • Assess for social drivers of health and work with Community Health Workers on integrated Care Management
  • Attend all Care Management training courses/webinars and meetings
  • Participate in quality improvement efforts by utilizing dashboards, tracking tools and providing quality reporting data monthly
  • Follow protocols, clinical policy and procedure in collaboration with the Primary Care Provider/Specialty Care provider
  • Perform in-clinic triage and medication refills
  • Conduct nursing assessments according to assessment tools to determine services and service level of care needed
  • Under provider direction perform and/or assist in inductions utilizing COWS, administer patient injections and provide education on naloxone
  • Provide education about Neonatal Abstinence syndrome, support systems, and concerns
  • Monitor medication adherence and check PDMP

Requirements

  • Associates Degree in Nursing
  • RN with two+ years related experience and/or training
  • Electronic Health Records, preferably Epic

Benefits

  • Medical and dental insurance
  • Employer paid group term life and disability
  • Employer contribution toward Health Savings Account
  • Flexible Spending Accounts
  • Paid Time Off (PTO), Paid Holidays and Paid Leave Bank
  • 403(b) with a 4% employer match
  • Various voluntary benefits: Vision Insurance, Supplemental Life, AD&D and Disability, Tuition reimbursement, Health and Wellness reimbursement program, Employee Assistance Program, and other specialized behavioral health services and resources for employees and family members
  • Partner of HRSA/NHSC loan repayment program

Job title

RN Care Manager

Job type

Experience level

JuniorMid level

Salary

$30 per hour

Degree requirement

Associate's Degree

Location requirements

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