RN, Care Manager Sr. (66252)

Department: Administration

Position:  RN Care Manager Sr

Employee Category:  Non-Exempt

Reporting Relationship:  Population Health Manager

Character Qualities:

• Alertness— Being aware of what is taking place around me so I can have the right responses.
• Dependability— Fulfilling what I consented to do, even if it means unexpected sacrifice.
• Flexibility—Willingness to change plans or ideas without getting upset.
• Sensitivity—Using my senses to perceive the true attitudes and emotions of others.

Summary of Duties and Responsibilities:

The senior RN Care Manager - Registered Nurse who directly supports Variety Care’s highest risk patients, with primary focus on at risk populations.  In collaboration with other members of the healthcare team, the RN Care Manager is responsible for organizing, coordinating, and providing care management services, within the practice, who are at risk for health deterioration, poor health outcomes, and/or avoidable utilization of emergency care services. 

Primary Duties and Responsibilities: 

1. Manage Variety Care’s high-risk patient population.
2. Conduct comprehensive assessment of patients’ physical, mental, and psychosocial needs.
3. Develop care plans to prevent disease exacerbation, improve outcomes, increase patient engagement in self-care, decrease risk status, and minimize hospital and ER utilization.
4. Reconcile patient’s medication list accurately and routinely.
5. Communicate with providers (e.g.; specialists, respiratory therapist, nutritionist, physical therapist, home health providers, care managers, and social workers) by optimizing the office-based care team to send, receive, and triage information flows among providers.
6. Utilize behavioral strategies including, but not limited to, Bridges out of Poverty, Crucial Conversations and Teach-Back techniques.  Promote self-management goals that help patients adopt healthy behaviors and improves self-care. 
7. Optimize the utilization of services available at Variety Care, including Behavioral Health, Social Services, Community Health Worker, Enrollment Services, Nutrition, Pharmacy, Optical and Dental.
8. Acts as a lead, for the care management team, of a subset of patients designated by the Population Health Manager, in coordination with the Director of Clinical Services.  Assist the team (consisting of Social Services staff and Community Health Worker(s)) to prioritize and intervene effectively to keep patients medically stable and improve their quality of life as well as health outcomes.
9. Coordinates/v