RN CARE MANAGER
On-siteHarlingen, Texas, United States
Job Summary
Supervise and direct the Care Management Team across four clinical sites, leading daily huddles to coordinate care, scheduling, and follow-up for patients with chronic and acute conditions. Implement evidence-based care management tools to enhance patient outcomes, review medical records for accuracy, and facilitate transitions of care through phone calls and appointment scheduling. Identify high-risk patients, establish disease management plans, and engage patients and caregivers in self-management goals while referring to social services and community resources. Collaborate with Value Based Care teams to ensure compliance with ACO, MCO, and insurance guidelines, participate in quality improvement projects, and serve as the alternate CNO. Manage department budgets, oversee in-service training, and maintain clinical standards across all sites.
Required Qualifications
- Licensed Registered nurse in the State of Texas
- Five-year experience as RN
- Supervisory experience
- Minimum 2 years experience in Care/Case Management
- Current with BLS/CPR
- Computer literate
- Bilingual (English/Spanish)
- Ability to bend, stretch, stoop, stand, sit, and lift 20 lbs
- Ability to complete basic/intermediate math computations and medical math conversions
- Ability to examine documents for accuracy and completeness
- Ability to maintain an effective and professional working relationship with the public and co-workers
- Ability to maintain client, office confidentiality and abides by confidentiality expectations and HIPAA guidelines
- Ability to read, write and speak in a clear, accurate and professional manner
- Active listening skills
- Understanding medical terminology
- Ability to recognize, evaluate, solve problems, correct errors and report to supervisor any issue
- Ability to resolve patient service issues
- Ability to work in a fast-paced environment
- Ability to apply critical thinking skills
- Multi-tasking
- Prioritization
- Attention to detail
- Knowledge of practice level procedures, techniques, and practice of patient care
- Knowledge of regulatory requirements, health plan contracts, governmental benefits and community resources
- Knowledge of SC policies and procedures
- Knowledge of the Chronic Care Model and Patient-Centered Medical Home Model (PCMH) and transition of Care management
- Ability to navigate EMR and download and upload data into other websites and portals
- Ability to review other data in EMR and research for specific diagnosis
- Ability to comply with enhanced infection control requirements of the clinic
- Ability to submit required documentation in a timely manner (credentialing requirements, license renewals, certifications, CNE attendance, etc.)
- Ability to respond to Rapid Response activations at all clinic sites where present
- Nursing duties as assigned and needed to bring Su Clinica nursing to standard and above standards per governing bodies
- Ability to work extended hours or other variations of the usual shift
Desired Qualifications
- Experience with Compliatrics
- Experience with Su Clinica training
- Experience with other web-based courses and educational programs
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