RN Care Manager - Comprehensive Care

Description :

The scope of practice includes, but is not limited to, providing case management to patients with complex medical conditions at high risk for hospitalization or worsening medical condition. You will interact with patients in the clinic setting, through telephonic or telehealth contact. You will attend and contribute to interdisciplinary team meetings. You will cover all counties within the state for which you are hired.

What You Will Do :

• Responsible for comprehensive patient assessments through medical records, clinician and patient interviews, telephonic and / or face to face.
• Have close follow-up with all patients amending care plans as necessary with each patient contact
• Educate patients, their families and / or caregivers.
• Assist patients, families or caregivers' education and support advanced care planning to include palliative care, and / or hospice care as appropriate.
• Communicates with the comprehensive care team and primary care physician regarding individualized care plans and patient's progress.
• Identifies patient care needs and barriers to care.
• Develops and implements plans to mitigate barriers to patient self-management or self-care.
• Prepares documentation according to workflows and policy.
• Works with patients, families and caregivers to promote self- management and meet care plan goals
• Build relationships with PCPs, internal and external customers.
• Communicate opportunities to advance clinical models.
• Confidently use associated technology and computers.
• Ensure patient privacy and adherence to all HIPAA regulations and standards for handling PHI.
• Participate in quality improvement initiatives, documentation audits, and other activities that support clinical excellence and operational efficiency.
• Maintain compliance with required training, timely chart closures, meeting attendance and other requirements.
• Serve as a positive and collaborative team member.
• Role model the company core values.
• Other patient care projects as assigned

What You Will Bring :

About Impresiv Health :

Impresiv Health is a healthcare consulting partner specializing in clinical & operations management, enterprise project management, professional services, and software consulting services. We help our clients increase operational efficiency by delivering innovative solutions to solve their most complex business challenges.

Our approach is and has always been simple. First, think and act like the customers who need us, and most importantly, deliver what larger organizations cannot do - provide tangible results that add immediate value, at a rate that cannot be beaten. Your success matters, and we know it.

That's Impresiv!