Telephonic RN Nurse Care Manager, Wisconsin
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Job Description
Nurse Care Manager enhancing health outcomes for high-risk patients at HarmonyCares. Managing personalized care plans and coordinating comprehensive services for patients' healthcare journey.
Responsibilities:
- Coordinates care services with pod leader to ensure that patients have access to a comprehensive set of services tailored to their needs throughout their healthcare journey
- Works collaboratively within the care team to develop and manage personalized care plans, address care gaps, and engage with other resources to ensure access to care
- Coordinates the transition of care for patients throughout the continuum to ensure patient needs are met accordingly and to ensure that avoidable hospital admissions do not occur
- Coordinates and facilitates High Risk Huddles along with ensuring that follow-up actions are completed
- Prioritizes patients based on the severity and urgency of their conditions to ensure that the most critical cases receive immediate attention
- Reviews medical records to identify gaps in care and coordinate services with the care team to manage these issues
- Regularly updates patient care plans
- Performs thorough nursing assessments via telephone of patients to maximize or improve current health outcomes
- Provides education to patients and/or their caregivers on disease education, medication, health maintenance, and disease prevention to promote self-management and improve health outcomes
- Demonstrates strong clinical skills, critical thinking abilities, and effective communication in their interactions with patients, caregivers, providers, fellow care team members, etc.
- Documents necessary interactions, assessments, updates, etc. in patients' medical records according to processes and guidelines
- Serves as liaison between patients, providers, resources, etc. to ensure seamless care delivery
- Facilitates communication of patient status and plan of care during transitional experiences such as home to hospital, hospital to post-acute care and back to home
Requirements:
- Active Registered Nurse License
- 2+ years of care management experience in community, health plan or hospital systems
- Possesses strong clinical skills and proactive thinking
- Effective communication skills
- Ability to perform extensive telephone assessment
- Knowledge of Medicare regulations and home care and hospice standards
- Experience with small group presentations and teaching/training
Benefits:
- Quarterly Bonuses
- Health, Dental, Vision, Disability & Life Insurance, and much more
- 401K Retirement Plan (with company match)
- Tuition, Professional License and Certification Reimbursement
- Paid Time Off, Holidays and Volunteer Time
- Paid Orientation and Training
- Day Time Hours (no holidays/weekends)
- Great Place to Work Certified
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