RN 2 Care Manager – GBMC Health Partners

JOB DESCRIPTION SUMMARY :

The RN Care Managers primary responsibilities are to oversee care management and coordination of clinical activities for a defined patient population and to promote population health management through effective education, self-management support, goal setting, care planning and timely health care delivery. This will include developing and monitoring care management processes and support for primary clinical teams with these efforts. The Nurse Care Manager will work cooperatively with the Practice Manager, Lead Physician Provider of the practice, Care Coordinator, Centralized Care Coordinator(s) and Behavioral Health Consultant(s) to best serve the needs of the identified patient panel. The RN Care Manager will serve as a clinical resource in the primary care setting.

Education

Bachelors of Science in Nursing required

Experience

At least 2 years of diversified, progressive experience in acute care and/or other settings within the continuum. Ambulatory Care Management experience a plus

Skills

Clinical assessment of patients including but not limited to; Social Determinants of Health, care planning, motivational interviewing, and patient education skills

Proficiency in developing a detailed and comprehensive nursing plan of care for patients with multiple comorbidities, high risk and rising risk patients, high utilizers, the implementation of effective nursing care, patient education, metrics, LDM, evaluating data, metrics and the outcome of nursing interventions

Analytical skills necessary to prepare and interpret reports

Effective planning and organizational skills to effectively manage multiple priorities simultaneously

Skills in oral and written communication to address inter- and intradepartmental concerns, problem solving and the ability to address patient needs and Social Determinants of Health

Demonstrates problem solving skills, the ability to research and evaluate innovative ways to use community resources

Computer, data analysis and personal productivity skills to enable effective use of EMR, e-mail, the internet, word processing, spreadsheets, presentations, and database packages

The ability to cover other practices and multiple practices, as needed

Licensures, Certifications

Current registration with the Maryland State Board of Examiners of Nurses as RN

Completion of “Healthcare Provider” CPR

Certificate or Certification in specialty related to your current practice within 3 years of hire

Physical Requirements

Ability to sit up to 90% of work time

Ability to concentrate and pay close attention to detail when filing, typing and proofing for up to fifty (50%) percent of work time

Ability to travel to multiple locations and cover multiple practices, as needed

Ability to travel to patient homes, as needed

Working Conditions

Primarily an ambulatory care setting, interviewing, assessing and educating patients and families, working with interdisciplinary staff up to 70% of time. Remainder of time in office environment

Conditions of Employment

Maintain current licensure and certifications