Nurse Case Manager, Integra - Care New England

Job Summary:

The Community Nurse Case Manager collaborates with a group of Physicians to pursue cost-effective, quality focused management interventions by achieving a predetermined financial and clinical outcome. Responsible for providing ongoing communication with Medicaid patients, continuing care coordinators, social workers, and physicians to ensure Medicaid patients have appropriate resources/support in the community and intervening when patients are unable to be managed adequately. Tracks Medicaid patients along continuum of care, identifying patterns that have a negative cost-quality impact and assists with the development of plans for improving care.

Duties and Responsibilities:

Leverage EMR and chronic disease registry reporting to prioritize patient outreach and follow-up.

Provide care management services under the direction of the practice manager or provider.

Complete initial patient assessments, including comprehensive medical, psychosocial, and functional evaluations.

Educate patients about specific chronic illnesses, including pathology, signs and symptoms, complications, and medications.

Ensure screening tests and immunizations are up to date.

Use behavior change techniques, such as motivational interviewing, to establish therapeutic relationships with patients.

Develop and implement patient care plans that promote improved health outcomes and quality of life, informed by patients' goals, strengths, and barriers.

Advocate for patients to ensure timely service delivery across the continuum of care and access to community resources.

Conduct medication reconciliations and provide support to enhance medication adherence.

Collaborate with caregivers to clarify patient needs and provide support to family members.

Document activities in EMR and generate reports on service volume and effectiveness.

Utilize a multidisciplinary team approach to plan and coordinate care, including quality improvement initiatives.

Requirements:

Registered Nurse with Bachelor’s Degree in Nursing or equivalent, with current RI license.

Minimum of 5 years related clinical experience, demonstrating recent knowledge of case management, utilization review, quality assurance, discharge planning, third party payor regulations and community health.

Experience must demonstrate high level of interpersonal skills, both oral and written, analytical skills, leadership abilities and effectiveness within a team environment.

Ability to speak a second language, Spanish preferred.

Experience working with the Medicaid population preferred.

Care New England Health System (CNE) and its member institutions, Butler Hospital, Women & Infants Hospital, Kent Hospital, VNA of Care New England, Integra, The Providence Center, and Care New England Medical Group, and our Wellness Center, are trusted organizations fueling the latest advances in medical research, attracting the nation’s top specialty-trained doctors, and honing renowned services and innovative programs to engage in the important discussions people need to have about their health.

Americans with Disability Act Statement: External and internal applicants, as well as position incumbents who become disabled must be able to perform the essential job-specific functions either unaided or with the assistance of a reasonable accommodation, to be determined by the organization on a case-by-case basis.

EEOC Statement: Care New England is an equal opportunity employer. All applicants will be considered for employment without attention to race, color, religion, sex, sexual orientation, gender identity, national origin, veteran or disability status

Ethics Statement: Employee conducts himself/herself consistent with the ethical standards of the organization including, but not limited to hospital policy, mission, vision, and values.