RN Care Manager - Hospital Transitions

apartment UNC Health location_onMorrisville, NC, US

Description

UNC Health Alliance is UNC Health’s statewide clinically integrated network and population health services organization. The mission of this team is to transform healthcare delivery on behalf of more than 7,200 providers by offering patient-centered solutions to populations covered under alternative payment models. Joining this team means you will work closely with providers, practices, payers, business leaders, and community partners to improve the quality and accessibility of care while lowering the cost of care for patients, payers, and businesses. We are a growing team looking for top talent to help us with creative solutions that improve patient care and help make healthcare more affordable. Become part of an inclusive organization with over 40,000 diverse employees, whose mission is to improve the health and well-being of the unique communities we serve.

We are in search of a Care Manager to join our team! This role woudld require occasional weekend rotation based on operational needs and service agreements .Applicants with 2 years of triage, care management, and/or care transitions experience are strongly preferred.

Become part of an inclusive organization with over 40,000 teammates, whose mission is to improve the health and well-being of the unique communities we serve.

Summary:
The Care Manager RN plays a crucial role in providing comprehensive and coordinated care to patients within UNC Health. This position involves utilizing a variety of skills, including risk segmentation, patient assessments, patient-centered care plans, tasks or interventions, care transitions, delegated work, and payer communication. The Care Manager works collaboratively with healthcare providers, patients, and their families to ensure that patients receive the highest quality of care and support throughout their healthcare journey.

Responsibilities:
1. Patient Assessments:
a. Conduct comprehensive care manager assessments utilizing standardized assessment tools and nursing knowledge to evaluate patients' functional abilities, cognitive status, and psychosocial support systems.
b. Identify any barriers to care and develop appropriate interventions to address them.
2. Patient-Centered Care Plans:
a. Collaborate with providers, patients, their families, and the healthcare team on individualized care plans that align with patients' goals, preferences, and values.
b. Ensure that care plans are evidence-based, culturally sensitive, and promote patient engagement and self-management.
3. Risk Segmentation:
a. Utilize standardized tools and clinical judgment to identify and assess the risk level of patients based on various factors such as medical conditions, social determinants of health, and behavioral health needs.
b. Develop strategies to effectively manage and mitigate risks for patients, ensuring their overall well-being and optimal health outcomes.
4. Tasks or Interventions: a. Coordinate and facilitate necessary tasks or interventions to support patients' care plans.
b. Collaborate with healthcare providers, community resources, and support services to ensure seamless coordination of care.
c. Advocate for patients' needs and rights, ensuring that they receive appropriate and timely interventions. d. Participates in quality improvement initiatives to ensure patient, departmental, and organizational goals/outcomes are met or exceeded.
5. Care Transitions: a. Coordinate and facilitate care across various healthcare settings, ensuring seamless transitions and continuity of care.
b. Communicate and collaborate with healthcare providers, specialists, and community resources to ensure comprehensive and coordinated care delivery.
c. Facilitate multidisciplinary care team meetings to discuss patients' care plans and progress.
6. Coordinated Work:
a. Coordinate care management tasks with other members of the healthcare team while maintaining accountability for the overall coordination and management of patients' care as applicable per patient population.
7. Payer Communication:
a. Collaborate with payers, insurance companies, and utilization management teams to optimize reimbursement and facilitate timely approvals for necessary care and services.
8. Accurately document and bill for services rendered, as applicable, in compliance with insurance and regulatory requirements.
a. Collaborate with billing and coding professionals, as applicable, to ensure compliance with coding and documentation requirements.
9. Longitudinal Care as part of the Medical Home (varies per patient population and care setting):
a. Act as a key point of contact and advocate for patients within the care team.
b. Provide ongoing support and care coordination throughout the patient's healthcare journey, ensuring continuity and comprehensiveness of care.

Other Information

Other information:
Education Requirements:
● Graduation from a state accredited school of professional nursing
● Magnet hospitals: BSN required or must be enrolled in an accredited program within 4 years of employment and obtain a bachelor’s degree with a major in nursing or a master’s degree with a major in nursing within 7 years of employment date.
Licensure/Certification Requirements:
● Registered Nurse with a valid license to practice in North Carolina.
Professional Experience Requirements:
● Minimum of 2 years of experience as a registered nurse.
Knowledge/Skills/and Abilities Requirements:
● • Strong knowledge of risk segmentation, patient assessments, patient-centered care planning, care transitions, and payer communication.
• Excellent communication, collaboration, and problem-solving skills.
• Ability to work independently and as part of a multidisciplinary team.
• Proficiency in electronic health records (EHR) and other relevant software applications.

Job Details

Legal Employer: NCHEALTH

Entity: Health Alliance

Organization Unit: Hospital Transitions

Work Type: Full Time

Standard Hours Per Week: 40.00

Salary Range: $35.52 - $51.05 per hour (Hiring Range)

Pay offers are determined by experience and internal equity

Work Assignment Type: Remote

Work Schedule: Day Job

Location of Job: US:NC:Morrisville

Exempt From Overtime: Exempt: Yes

This position is employed by NC Health (Rex Healthcare, Inc., d/b/a NC Health), a private, fully-owned subsidiary of UNC Heath Care System. This is not a State employed position.

Qualified applicants will be considered without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, age, genetic information, disability, status as a protected veteran or political affiliation.

UNC Health makes reasonable accommodations for applicants' and employees' religious practices and beliefs, as well as applicants and employees with disabilities. All interested applicants are invited to apply for career opportunities. Please email applicant.accommodations@unchealth.unc.edu if you need a reasonable accommodation to search and/or to apply for a career opportunity.

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Evaluation of Care - Identifies expected patient outcomes. Seeks guidance as needed in revision of plan of care. Participates in discussion with members of the interdisciplinary team in evaluation of patient care. Communicates relevant information to promote continuity of care. 3. Implementation - Demonstrates competence in care of patients with complex problems, including population-appropriate physical, psychosocial, educational and safety aspects of care. Performs bedside point of care testing as required for patient care plan. Utilizes healthcare organization and nursing standards, policies and procedures in delivery of care. Organizes and prioritizes care according to patient/family needs. Consults with appropriate resources in a timely fashion regarding patients with complex care issues, unusual teaching needs and/or those at high risk for discharge planning. 4. Leadership - With assistance, develops goals to promote professional growth or minimize limitations. Achieves goals and objectives within identified time frame or renegotiates with supervisor. Is knowledgeable about activities which facilitate intra/interdepartmental collaboration. Participates in development and achievement of unit goals and performance improvement activities. Effectively uses communication systems. Participates in promoting cost-effective care. Gives feedback to co-workers. Is aware of public policy and regulatory guidelines affecting the health care environment. Promotes a safe, clean and secure hospital environment for all. 5. Patient Assessment - Recognizes data from complex situations to determine priorities for care. Includes appropriate physical, psychosocial, education and safety needs. Synthesizes assessment data into meaningful whole prior to communication to others. Assesses and anticipates discharge needs of individual patients and families. Develops relationships with families that promote their ability to advocate for the patient and their own needs. 6. Planning - Collaborates with patient/family to prepare or update the plan of care. Makes use of available multidisciplinary resources in planning care. Begins to use full range of communication as a means to convey planning. Identifies and addresses cultural and ethnic issues in planning patient care. Demonstrates ability to prioritize tasks for patients with complex problems. 7. Research - Reads journals that contain studies or articles that may be applicable to practice. Brings ideas and questions to the staff at large for assessment of applicability. Other Information Other information: Education Requirements: ● Graduation from a school of professional nursing. ● If hired after January 6, 2014, must be enrolled within four years of employment, and obtain a Bachelor's degree with a major in Nursing or a Master's degree with a major in Nursing within seven years of employment date. Licensure/Certification Requirements: ● Licensed to practice as a Registered Nurse in the state of North Carolina. ● Basic Life Support (BLS) for Healthcare Provider certification Professional Experience Requirements: ● One (1) year of nursing experience. Knowledge/Skills/and Abilities Requirements: Job Details Legal Employer: STATE Entity: UNC Faculty Physicians Organization Unit: HMOB GI Procedure Work Type: Full Time Standard Hours Per Week: 40.00 Salary Range: $33.88 - $47.91 per hour (Hiring Range) Pay offers are determined by experience and internal equity Work Assignment Type: Onsite Work Schedule: Day Job Location of Job: US:NC:Hillsborough Exempt From Overtime: Exempt: No This is a State position employed by UNC Health Care System with UNC Health benefits. If, however, you are presently an employee of another North Carolina agency and currently participate in TSERS or the ORP, you will be eligible to continue participating in those plans at UNC Health. Qualified applicants will be considered without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, age, genetic information, disability, status as a protected veteran or political affiliation. UNC Health makes reasonable accommodations for applicants' and employees' religious practices and beliefs, as well as applicants and employees with disabilities. All interested applicants are invited to apply for career opportunities. Please email applicant.accommodations@unchealth.unc.edu if you need a reasonable accommodation to search and/or to apply for a career opportunity.