RN Care Manager ensuring smooth transitions for patients post-discharge in a value-based healthcare setting. Collaborating with interdisciplinary teams for comprehensive patient care.
Responsibilities
Work directly as a member of the Arkos Health Interdisciplinary Team
Implement and participate in the patient’s plan of care; update and revise as needed
Assist in coordination of comprehensive care; including obtaining referrals to other interdisciplinary services (Home Health, Palliative Care, Social Services) to help prevent further need for acute care utilization
Maintain case load based on the needs of the client and/or contractual obligation
Conduct face to face visits at a minimum of every 2 weeks for assigned patients enrolled in Intensive Case Management. May conduct increased face to face or telephonic visits based on the needs of the patient and or contractual obligation
Complete Clinical and Social Assessments (CSA) to develop care plan upon initial start of care visit with patient
Provide communication with patient’s providers and medical specialists regarding patient status and any changes in condition
Engage with Arkos Health leadership and contracted providers to resolve changes in patient status, complaints, or complications though participation in weekly ICT meetings
Complete medical reconciliation for all transitional care patients within 30 days of initiation of TCM contact
Requirements
Current, unencumbered, Registered Nurse License/ and graduation from an accredited Registered Nursing program required
Current BLS/CPR certification required
Current TB test and maintain a negative test annually required
Hep B vax/titer proof (Company does offer/or may sign a declination) required
Current flu shot (or sign waiver/follow mask policy) required
Having an in-depth knowledge of health care services and other medical terminology is a required
Excellent communication, critical thinking, and time management skills required
Proven experience with developing and revising care plans based on patient needs is highly preferred
Proven experience working in or with a managed care organization in a field-based or hybrid environment to achieve value-based care is highly preferred
Strong technology skills and experience with electronic documentation tools are essential
Experience with disease management programs a plus
Benefits
Employer-paid Medical, Dental and vision premiums at no cost to you
Employer-paid Short-Term Disability premiums at no cost to you
Employer-paid Life Insurance premiums at no cost to you
Employer matching 401(k)
15 days annual combined sick/vacation during your first year
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