Chronic Care Case Manager - RN

Description

$30-$40 per hour

8:30am-4:30pm (40 hours per week)

Health Benefits Start Day 1 (Medical/Dental/Vision/STD/LTD/Life/Pet, etc.) 

10 Paid Holidays Off Annually

401K Match

Paid Time Off - 25 days accrued per year (5 weeks)

Position Summary

Primarily supporting the organization’s Manager of Clinical Education and Digital Support, the Chronic Care Case Manager RN supports patient care by managing caseloads taken from populations that meet requirements for various quality programs. The case manager works closely with the patients, support staff, HHS leadership, clinicians, and the quality department to achieve goals of improving clinical outcomes for patients with chronic disease. They also work in accordance with the Heartland Health Services’ (HHS) mission, strategic goals, federal and state laws, regulations, performance and outcome objectives, and accreditation standards.? 

Essential Functions  

• Manages the caseload of an assigned panel of chronic care patients.? 
• Collaborates with physicians, clinicians, and practice staff in identifying appropriate patients for care management.? 
• Assists clinicians with patient care plans.? 
• Develops relationships with patients as an integral member of the team.? 
• Provides follow-up management with patients to ensure compliance with their individual care plan.? 
• Maintains availability to provide telephone advice per protocol, along with handling urgent and emergency calls.?? 
• Anticipates the needs of the patient population, seeing that necessary documentation and pre-visit planning is completed or requested before the patient visits/calls.? 
• Promotes patient self-management and empowers patients/families to achieve maximum levels of wellness and independence.? 
• Determines and coordinates appropriate referrals, whether medical or SDOH support, as needed.? 
• Collaborates with the patient, physician, and other care team members in assessing the patient’s progress toward individual healthcare goals. Assists patients in setting achievable goals for self-management, teaches them how to do self-management tasks, and reports abnormal findings to their care team.? 
• Assesses barriers when the patient has not met treatment goals, is not following the treatment plan of care, or has not kept important appointments.? 
• Gathers and manages data for clinical outcome measurements and participates in research programs as needed.? 
• Supports clinic compliance with all applicable federal, state, local, and HHS rules, regulations, protocols, and procedures governing the clinical provision of medical services as well as those relating to, but not limited to, workplace safety, public health, and confidentiality.? 
• Supports and is involved in HHS’s continuous quality improvement efforts designed to improve patient outcomes.?? 
• Works in consultation with clinical teams, direct clinical support staff, and indirect clinical support staff to develop and implement policies and procedures that maximize patient-centered communication and services.? 
• Maintains and assures confidentiality of patient information in accordance with HHS’s policies.?? 
• Reports building/equipment problems through the appropriate channels.? 
• Performs any clerical duty or department-related task as assigned in a continuously changing medical practice.? 
• Attends all staff meetings, department meetings, and any other meetings as required.? 
• Performs each assigned essential duty to a satisfactory level.? 

Requirements

Job Qualifications (Required)

• Understanding of chronic diseases and preventive care measures and ability to use medical decision making to effectively triage chronic care management patients.? 
• Hold Illinois licensure as a RN with at least two years’ experience as a RN.? 
• Strong writing and interpersonal/communication skills.? 
• Ability to define problems, collect data, establish facts, and draw valid conclusions.? 
• Basic MS Office skills (Word and Excel).? 
• Ability to work independently and, if needed, travel to all HHS clinics. Ability to maintain confidential information.? 
• Ability to communicate effectively and respectfully with people of diverse, professional, educational, and lifestyle backgrounds.? 
• Ability to work independently and assume responsibility for timely completion of assigned functions.? 
• Outstanding customer service and phone communication skills.?? 
• CPR certification.? 

Job Qualifications (Preferred)

• Bachelor’s degree in nursing. 
• Prior experience with Epic EMR.? 
• Prior phone triage nurse, case management, and/or chronic care management