RN Case Manager PT

Summary

The RN Case Manager provides quality and comprehensive patient care through the development, implementation and evaluation of individual patient medical care plans, while following established professional standards of care. Functions as an integral part of the patient-centered medical team and is a liaison between FHC patients and their family.

Essential Duties and Responsibilities

• Coordinate medical and specialty care for Family Healthcare patients.
• Facilitate communication and collaboration among medical, nursing, behavioral health, and social service providers.
• Promote a patient-centered, holistic approach to care and treatment.
• Identify patients with chronic disease risk factors and support proactive care planning.
• Monitor patient progress toward disease-specific self-management goals and program benchmarks.
• Provide care for medically complex patients, including those with mental health conditions and substance use disorders.
• Participate in interdisciplinary team consultations and weekly care reviews.
• Analyze quality outcomes data and collaborate with the care team to improve performance.
• Conduct home visits and specialty medical visits as clinically appropriate.
• Maintain strict patient confidentiality and always uphold professional standards.
• Support the organization's mission, vision, and values in all interactions with patients, staff, and visitors.

Additional Responsibilities

• Assist with special projects and other duties as assigned by the Chief Nursing Officer.
• Take ownership of ongoing professional development and competency in health assessment and disease management.
• Demonstrate professionalism in all communications and actions.

Qualifications - Education/Experience

• Current RN License and CPR certification, experience with EHR, and 2-5 years of experience in public health, community health, home care or hospital care, providing managed care patient services.
• Ability to develop effective interpersonal relationships with health providers and management.
• Ability to perform duties across life cycle (infant, children, adolescents, adults, prenatal and geriatric).
• Driver's license and clean driving record is required.
• Demonstrated organization skills, time management and ability to manage multiple cases.
• Strong communication skills, writing and verbal. Bilingual in English and Spanish strongly preferred.
• Knowledge and experience in HIPAA regulations, information privacy/security laws, and access and release of information.
• Knowledge of infection control protocols and experience in teaching/educating patients about care of chronic diseases.
• Computer proficiency.

Required Vaccines and Tests

Influenza, Tdap, Hep B, MMR, Varicella, TB test, and Negative Drug Test results. Additional Vaccines may be required.