RN Care Manager

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Description

Northeast Health Center - 3908 Meadows Drive, Indianapolis, IN 46205

The Care Manager is responsible for coordinating screenings, assessments and providing care management services to patients identified as having complex chronic care needs, or with identified patient populations. Acts as a connector between patient needs and the resources provided by the care management program. The Care Manager will promote self-care management, assist with access to care, and work with patients through telephonic patient interactions. Provides guidance and leadership in the care management program to those in the healthcare organization as well as ensuring the patients receive the best possible care. The Care Manager reports to the Manager of Quality and Performance Improvement.

Patient/Client Care
? Identifies, tracks and manages care for the highest risk patients, or assigned patient populations
? Conducts initial care coordination screening eligibility and performs comprehensive risk assessment
? Perform follow-up activities with patients as needed after emergency department visits, and/or in-patient discharge.
? Assist with scheduling medical and specialty appointments. Provide reminder phone calls for appointments and/or follow-up calls post appointment
? Works directly with patients/family members and providers to develop and implement an individualized and integrated patient care plan for each of the highest risk patients.
? Utilizes motivational interviewing to gain cooperation from patients and families around the care management plan.
? Ongoing clinical assessment, monitoring and follow up for the high-risk patients
? Utilize standing orders and clinical orders for chronic disease management within scope of clinical practice and per individual medical home policies and procedures.
? Performs medication review, reconciliation and coordination with a licensed professional for medication adjustment
? Assists in the maintenance of the patient?s health, wellness and prevention of secondary disease complications by providing education, counseling and support
? Handles protective health information in a manner consistent with the Health Insurance Portability and Accountability Act (HIPAA)
? Ensures the ongoing and timely reassessment and follow-up of all care plans on a scheduled basis ensuring timely updating and documentation of patient progress toward agreed upon goals.
? Contributes towards and promotes the coordination of relevant health and social care services to remove barriers related to social determinants of health

Documentation & Data Collection
? Maintain timely and appropriate documentation on patient interactions in the care management system.
? Perform social determinant of health (SDoH) assessments.
? Perform population management activities as assigned.
? Implements the Chronic Care Management program with eligible patients.

Administrative
? Assist in planning and implementation of special projects and perform other activities as assigned.
? Attend all required meetings, case conferences, and trainings as assigned by supervisor.
? Immediately report problems or unusual occurrences to immediate supervisor, or other HealthNet leadership as appropriate.

Commitment to Purpose/Service
? Demonstrates a commitment to HealthNet?s mission, vision and values and supports organizational decisions and behaviors.
? Demonstrates efforts to discovering, meeting and advocating for patient and customer?s needs.

HIPAA
? Maintains at all times the confidentiality of any patient or employee medical, financial, or other personal information, records and data to which there is access.
? Views, uses or discloses such information only for reasons necessary to perform duties.
? Responsible to challenge unauthorized individuals from viewing such confidential patient or employee information or accessing restricted areas.
? Maintains high level of integrity in dealing with highly confidential and often sensitive information, earns trust and respect of others, and exhibits behaviors that express the ethical practice of a healthcare organization.

Diversity & Inclusion
? We commit to fostering a diverse, inclusive, and equitable work environment, where all employees, whatever their gender, race, ethnicity, national origin, age, sexual orientation or identity, education, or disability, feels valued and respected.
? We take a nondiscriminatory approach and provides equal opportunity for employment and advancement in respective departments, programs, and worksites.
? We strive to respect and value diverse life experiences and heritages and ensures that all voices are valued and heard.
? We pledge to modeling diversity and inclusion and to maintaining an inclusive environment with equitable treatment for all.

Job responsibilities listed above is a summary and does not include other tasks requested by the hiring manager.

Who is HealthNet?

https://www.indyhealthnet.org/

HealthNet is a nonprofit 501 (c) (3) organization of community-based health centers located in Indianapolis and Bloomington, IN Since 1968, HealthNet has improved the health status of the neighborhoods it serves by making quality health services accessible to everyone. HealthNet annually provides affordable health care to more than 61,000 individuals through its network of 9 primary care health centers 5 dental clinics, 9 school-based clinics, a mobile health unit, and additional support services. HealthNet?s mission is to improve lives with compassionate health care and support services, regardless of ability to pay.

Requirements

Qualifications, Knowledge, Skills, Abilities
? Currently not sponsoring for work visa.
? Requires an Associates of Nursing; Bachelor of Nursing Preferred.
? Requires state of Indiana license as a Registered Nurse.
? Requires 3-5 years of experience with 1-2 years disease management or care management as RN.
? Experience with the Chronic Care Management (CCM) Medicare program.
? Displays strong time management and organizational skills in a high intensity work environment.
? Demonstrates problem solving, decision making, and sound judgment as well as customer service skills.
? Experience working in a primary care, community-based environment.
? Knowledge of social determinants of health and clinical knowledge related to the patient population.
? Ability to assimilate complex information and communicate this effectively at all levels.
? Exceptional organizational and interpersonal skills, with attention to detail required; strong oral/written communication skills are a must
? Requires computer experience utilizing Microsoft products. Additional experience with Electronic Medical Record systems preferred.

Physical Requirement
? Prolonged periods of sitting at a desk and working on a computer.
? Must be able to lift up to 20-30 pounds at times.

Why work for HealthNet?
? Competitive Compensation
? Medical, Dental, and Vision Plan
? Short-Term & Long-Term Disability
? Health Savings Account & Difference Card Available within certain medical plans
? Flexible Spending Account
? Life Insurance, AD&D
? Group Accident, Critical Illness & Hospital Indemnity
? Domestic Partner Leave
? Wellness Programs
? 401k Match
? Paid Time Off accumulates at start of employment and available to use.
? Tuition Reimbursement
? Employee Referral program

Equal Employment Opportunity

HealthNet is an Equal Employment Opportunity Employer and employment decisions are made without regard to race, color, sex, religion, national origin, age, disability, sexual orientation, or any other category protected by federal, state, or local law.

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