Care Management Nurse

Job Title: Care Management Nurse

Reports To: Nursing Care Management Supervisor

Job Summary: Assists clinical staff and providers in the administration of patient care, population management, and care management in assigned clinical areas.

Qualifications and Requirements:

To perform this job successfully, an individual must be able to perform each essential job duty satisfactorily. The requirements listed below are representative of the knowledge, skill, and/or ability required.

Essential Job Duties:

• Provides Clinical Nursing Support
• Assists providers and assigned care team to meet population health goals by conducting health screenings, immunizations, and chronic disease management with focus on care managed patients.
• Assists care team and provider with Medicare wellness visits for assigned providers Panel
• Completes pre-visit planning to identify needs for care management services
• Completes provider orders for procedures that require advanced clinical and/or nursing skills.
• Provides patient education as directed by provider and within scope of practice.
• Assists in developing educational materials for patients and staff.
• Assists in providing clinical training and support to medical support staff.
• Assists in conducting triage (with registered nurse license) or gathers information regarding urgent patient needs and communicates with provider to resolve patient care issues promptly.
• With Registered Nurse license, takes critical test results such as labs and diagnostics and facilitates notifying provider and assuring prompt action is taken as directed by provider.
• Documents and maintains records of verbal and written procedures, medication, delivery of care, and pertinent information regarding patient care services.
• Complies with infection control policies and protocols; follows medication administration, storage procedures and controlled substance regulations.
• Ensures operation of medical equipment by completing preventive maintenance requirements, following manufacturers instructions, reporting malfunctions, requesting repairs, maintaining equipment inventory, and evaluating new equipment and techniques.
• When needed, performs lab draws, conducts CBC analyzer tests, and maintains laboratory documents.

• Care Management
• Facilitates co-management of patients through transitions of care and referral with timely communication, inquiry, follow-up, and integration of information into the care plan. ?
• Develops care plans in collaboration with patient, family/caregiver(s), providers, and other clinical staff.
• Monitors patient adherence to care plans and evaluates effectiveness.
• Identifies patient progress and facilitates changes to care plans as needed.
• Assesses patient unmet health care and social needs.
• Assists in developing and implementing ongoing processes to determine and request the level of care coordination support that patients and caregiver(s) need and/or desire.
• Facilitates patient access to appropriate medical and specialty providers and other care givers.
• Educates patient and family/caregiver(s) about relevant community resources. ?
• Facilitates and attends meetings between patient, family/caregiver(s), care team, payers, and community resources, as needed.
• Assist care team in the administration of patient care for care managed patient, and as back up for medical support staff with assigned panels.

Additional Job Duties:

• Responds to incoming unmatched refill requests for assigned provider from pharmacies.
• Takes incoming calls from patients who have questions regarding medication refills or prior authorizations.
• Refills medications if appropriate and under approved standing orders
• Reviews all incoming Transition of Care/Referral Documents received as Consolidated Clinical Document Architecture (CCDAs) and reconciles medication lists and active diagnoses as appropriate per assigned provider.
• Notifies providers of new diagnoses or changes in medication regimens when appropriate for assigned provider panels.

Required Education, Experience, Certificates & Licenses:

• Degree from an accredited nursing program.
• Current Unrestricted Arizona State Nursing (RN or LPN) license.
• Cardiopulmonary Resuscitation (CPR) certification required.

• Driver's License and Proof of Insurance may be required if requesting mileage reimbursement.
• Valid Fingerprint Clearance Card may be required.

Preferred Education, Experience, Certificates & Licenses:

• Experience in a clinical setting preferred.

Required Language Skills:

• Ability to comprehend and compose instructions, correspondence, and communications in English in both oral and written format.
• Bilingual in English and Spanish is preferred, but not required.
• Ability to effectively present information in one-on-one and small group situations to patients, internal providers and staff and other agency staff working in cooperation with the organization.

Physical Requirements:

• Ability to frequently exert enough force to move objects weighing up to 25 pounds.
• Ability to continuously remain in a stationary position.
• Ability to constantly move about inside the workplace to assist patients, operate office or medical equipment, etc.
• Possesses hand-eye coordination and manual dexterity necessary to constantly operate computer, telephone, other office machinery, and medical equipment.
• Possesses close visual acuity necessary to accurately record and view information on a computer monitor, handwritten and typed documents.
• Ability to discern the nature of sounds at a normal spoken volume.
• Possesses range of body motion and ability to exert enough force to lift and move adult and pediatric patients.

Other Required Knowledge, Skills, and Abilities:

• Ability to perform medical math that may include the use of ratio/proportion, dosage calculation, metric and household equivalents, roman numerals, abbreviations, and general math including percentages, etc.
• Ability to gather data in an organized fashion from varied sources.
• Ability to perform a variety of assignments and make decisions requiring independent judgment.
• Ability to resolve challenges and work under pressure.
• Knowledge of health plans and community health centers preferred.
• Knowledge of HIPAA rules and regulations.
• Computer literacy required.

• Ability to prioritize and plan work activities, use time efficiently and develop realistic action plans.

Work Environment & Conditions:

• Work environment is typical of a health clinic setting with occasional exposure to communicable diseases, bodily fluids, and hazardous chemicals.
• Work occasionally involves use of needles and other medical equipment with proximity to electrical current, and exposure to moving mechanical parts and some hazardous chemicals.
• Work requires reliable transportation as position requires frequent travel and extended hours to include early mornings, evenings, and weekends.