Job Summary

The Nurse Care 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 patients, continuing care coordinators, social workers, and physicians to ensure patients have appropriate resources/support in the community and intervening when patients are unable to be managed adequately. Tracks patients along with 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

Collaborate with a selected group of physicians to pursue cost-effective quality focused management interventions by achieving a predetermined financial and clinical outcome.

Function as a patient advocate determining exactly what community services are required and the ways to assist with securing those services.

Provide ongoing communication with patients, continuing care coordinators, social workers and physicians to ensure the patient has the appropriate resources/support in the community

Intervene with patients who are unable to be managed adequately due to significant variation from expected outcomes or unanticipated complications.

Identify patients needing Community Case Management intervention through inpatient care manager, MD or VNA notification.

Ensure adequate follow up care is available to the patient at case closure.

Track patients along the continuum of care identifying patterns that have a negative cost-quality impact. Summarize specific deviations and assists with the development of plans for improving care.

Establish relationships with professional and/or health-related groups within the community.

Shar care coordination expertise with professional and supportive personnel.

Document and report communications/interventions in an accurate, timely manner using appropriate forms and records.

Identify, analyze, and resolve patient care problems to foster significant improvements in patient care and demonstrates a commitment to improving the quality of care provided to patients.

Perform other related duties as assigned.

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.

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

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.