Nurse Care Manager
Company: Avidity Exchange LLC
Location: Escondido
Posted on: February 14, 2021
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Job Description:
Nurse Care Manager PLEASE PROVIDE A PERSONAL EMAIL AND CONTACT
PHONE NUMBER WHEN APPLYING Nurse Care Manager Nurse: Management San
Diego, CA Full-time Key qualifications Licenses and certifications
RN Minimum education Bachelors Languages English Years of
experience 3+ years 1. Excellent benefits and great bonus structure
2. Reimbursement for childcare and elder care 3. Matching 401(k) 4.
Reimbursement for continuing education Skills for This Job: 1.
Current RN License, BSN preferred 2. 3-4 years of clinical practice
in a hospital, clinic, home care, or nursing home setting 3. 1-2
years of utilization management experience a must 4. Case
management experience desired 5. Disease management experience
useful 6. Physician office experience helpful Details OBJECTIVE The
Nurse Care Manager (NCM) is responsible, as part of the care team,
for the overall patient Care Management process. The NCM provides
oversight, guidance and support for the member care plan as
developed through clinician, NCM and allied clinical support
evaluation and physical risk assessment. The NCM uses nursing
assessment and evaluation skills to help guide treatment and care
decisions of the team and also identifies services and vendors for
needed care while navigating patient benefit plans. The NCM works
collaboratively with a multidisciplinary team of PCP, specialists,
Behavioral Health clinicians, midlevel practitioners, pharmacist,
nutritionist and social worker and the member, family and/or
caregiver as they provide supportive care to enrolled members. The
NCM ensures that medical services are managed in the most effective
and appropriate health care setting according to the members
medical condition. The NCM is responsible for developing and
implementing a plan of care appropriate to the members clinical
condition and psycho/social needs to maximize his/her level of
functioning and establishing and maintaining communications with
the responsible party of the member. SUMMARY Acts as an advocate
for the member in all activities including nursing assessments,
care coordination, care plan development, and communication. This
position is accountable for identifying and developing innovative
actions to meet the needs of the member from both the health care
and psychosocial / socioeconomic dimensions of care as well as
taking action for provision of services to meet those needs. The
NCM utilizes nursing assessment skills and decision making
authority to make recommendation and direct member care to meet the
needs of the member and support the care recommendations of the
multidisciplinary care team, the member, family and caregiver.
Complete an initial member assessment on all new enrolled members,
including a medical record review where available Documentation of
current advance care directive status and ongoing efforts to
reconcile member/caregiver misaligned goals with current clinical
status Perform ongoing assessments commensurate with member risk
level and/or identified need Development of a plan of care to
establish a collaborative approach to member needs across
clinicians and care delivery Initiate and maintain ongoing
communications with clinicians involved in member care, especially
PCP May meet with families/responsible parties for collaboration on
member plan of care and discussion of member/family/responsible
party contribution to the ongoing management of member condition
Coordinate care across the continuum of care delivery model as the
point of contact for member/caregiver and clinicians Act as liaison
between providers, nursing facilities, hospitals and program staff,
including making recommendations about care alternatives or
equipment that will aide in the safety of the member while
promoting optimal clinical outcomes Monitor member progress to plan
of care goals with emphasis on member care need during transitions
and changes in member level of care needs Monitor member during
admissions to both acute and skilled level of care to support
member needs, establish as the point of contact to clinicians and
member/responsible party/families to ensure consistent and ongoing
communication between all involved parties Provide nursing/assisted
living facility and provider training on program philosophy and
approach to member care Main educator for members and/or
families/responsible parties on disease processes and ways to
manage disease progression as independently as possible Reviews
medical information collected including medical records and/or
performs additional assessment to facilitate medical necessity
determinations regarding service requests as established with in
the identified program guidelines and the state established nurse
scope of practice Serve as a resource to the entire care delivery
team Identification and reporting of any quality of care issues
Maintain HIPAA compliance as it relates to member care SUPERVISORY
Reports to the Health Services Director. EDUCATION AND EXPERIENCE
Current RN License, BSN preferred 3-4 years of clinical practice in
a hospital, clinic, home care, or nursing home Setting 1-2 years of
utilization management experience a must Case management experience
desired Disease management experience useful Physician office
experience helpful PHYSICAL DEMANDS Below are the physical
requirements which are representative of those that must be met by
the employee to successfully perform the essential functions of the
job. Reasonable accommodations may be made to enable individuals
with disabilities to perform the essential functions. 1. Regular
requirement to sit; use hands to touch, handle or feel. 2. Regular
requirement to talk and listen. 3. Occasional requirement to stand;
walk and reach with hands and arms 4. Occasional requirement to
lift and/or move up to 10 pounds. 5. Vision abilities include close
vision, peripheral vision, depth perception and ability to adjust
focus.
Keywords: Avidity Exchange LLC, Escondido , Nurse Care Manager, Healthcare , Escondido, California
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