What are the responsibilities and job description for the High Risk Care Manager, Registered Nurse (.8 FTE) position at Neighborcare Health?
Purpose
The Registered Nurse works in partnership and joint accountability within an interdisciplinary team to achieve Neighborcare’s Mission, Guiding Principles and goals. The primary focus of the RN, High Risk Care Management is to optimize the health status of patients through focused care management, including chronic condition management and transitions of care. RNs build relationships with their patients through face-to-face and telephonic care and work in partnership with other care team members to meet the needs of patients throughout Neighborcare Health. The RN follows the Nursing Process to assess, plan, implement and evaluate nursing care in a Patient Centered Medical Home.
Health, Wellness & Retirement Benefits
Primary Responsibilities
Preferred Skills:
Since 1968, Neighborcare Health has been removing barriers to health care for our neighbors. We believe everyone deserves a place to call their health care home, where a team of medical, dental and mental health professionals work in collaboration with each patient to develop a personal health improvement plan.
We are one of the largest providers of primary medical, dental and behavioral health care services in the Seattle area serving low-income and uninsured families and individuals, seniors on fixed incomes, immigrants, and people experiencing homelessness. Each year we care for nearly 60,000 patients at our nearly 30 non-profit medical, dental and school-based clinics. We ask everyone to pay what they can, but no one is turned away due to inability to pay.
Our clinics are located in neighborhoods where health disparities are the greatest, and our care teams, who speak over 55 languages and dialects, are as diverse as our patients. No matter who you are, or where you come from, regardless of your insurance, income or immigration status, you are welcome at Neighborcare Health.
Learn more about us here.
The Full Job Description Is Available Upon Request
Full job description will be provided during the selection process.
The Registered Nurse works in partnership and joint accountability within an interdisciplinary team to achieve Neighborcare’s Mission, Guiding Principles and goals. The primary focus of the RN, High Risk Care Management is to optimize the health status of patients through focused care management, including chronic condition management and transitions of care. RNs build relationships with their patients through face-to-face and telephonic care and work in partnership with other care team members to meet the needs of patients throughout Neighborcare Health. The RN follows the Nursing Process to assess, plan, implement and evaluate nursing care in a Patient Centered Medical Home.
Health, Wellness & Retirement Benefits
- Medical, Dental & Vision insurance
- Paid time off & paid holidays
- Retirement with contribution match
- Life & AD&D, pet insurance
- Employee assistance program, & more!
- The target wage range for this position is $44.20 per hour to $54.67 per hour.
- Final offers are individually based on various factors, including skill set, years of experience, location, qualifications, work schedule and other job-related reasons.
Primary Responsibilities
- Provide care to defined panels of patients in the outpatient clinic setting and work as members of Neighborcare’s nurse team
- Maintain joint accountability to the clinic team and to the medical program as a whole, to include supporting colleagues throughout the organization either on site or remotely as needed
- Work with team members and leaders to define and reassess priorities and plan, communicate, and execute care delivery
- Participate in Quality and Performance Improvement efforts at the site/program to improve patient outcomes
- May serve as a preceptor for new staff and/or students who are assigned to Neighborcare as part of their professional education
- Participate in the design, pilot, and implementation of Neighborcare’s Patient Outcome Panel Support, a team-based Care Management model
- Follow the Plan-Do-Study-Act approach to continuous improvement in partnership with Neighborcare Health Quality team
- Research and apply best-practices and community standards for Care Management
- Develop and share subject-matter expertise in Neighborcare POPS processes with other members of the care team
- Establish partnerships with patients and families in person and via telephone for positive outcomes in health status
- Identify patient goals for improving their health status and management of chronic physical and mental health conditions
- Assess patient understanding of their condition and readiness to change
- Provide patient with education about the disease process; offer tools and skills needed to achieve self-management goals
- Monitor, track, and follow-up with patients to ensure care needs are met utilizing patient panel reports
- Coordinate care with outside providers and resources
- Apply Neighborcare Health guidelines and standing orders and evidence-based clinical practices
- Provide patient education across the lifespan in person and over the phone (select roles may focus on specific patient populations, including pediatric, perinatal, or individuals experiencing homelessness)
- Assess barriers to learning and tailor education to meet patients’ individual learning styles and needs
- Educate patients about medications, abnormal laboratory results, and self-management of acute and chronic conditions
- Promote wellness and the importance of preventive care
- Provide motivational interviewing and harm reduction counseling
- Knowledge and understanding of a broad range of physical and mental health conditions throughout the lifespan
- Ability to work effectively with patients and communicate effectively and respectfully with people of varied cultures, ethnic, language (including use of interpreters), educational and socio-economic backgrounds as well as individuals with disabilities and contagious diseases
- Knowledge, skill and ability to provide pregnancy and contraceptive options counseling
- Knowledge of medical terminology and clinical procedures; anatomy, physiology, biology, human growth and development; asepsis and universal precautions; medical documentation
- Ability to demonstrate reliable and timely attendance
- Ability to start and operate emergency equipment, perform CPR, and provide basic first aid, and respond professionally in emergent situations
- Skills in the use of personal computers, Electronic Health Records, e-mail, and other software programs and reports
- Skills in written and verbal communication in English and basic math
- Ability to comply with HIPAA/Confidentiality policies and procedures and to handle confidential and sensitive patient and staff information
- Ability to work effectively independently and as part of a team, interact appropriately with co-workers and patients, and develop and maintain rapport with a wide range of individuals
- Ability to demonstrate flexibility, adaptability, willingness and openness to learn and change
- Ability to follow written and verbal directions and to complete assigned tasks in a timely manner
- Ability to be detail-oriented and handle multiple tasks under stressful conditions, including organizing and problem solving in a creative manner
- Ability to demonstrate sound clinical judgment and work resourcefully and independently in the absence of detailed instructions
- Ability to work with supervision, receiving instructions/feedback, coaching/counseling and/or action/discipline and learn from directions, observations and mistakes
- Ability to effectively perform job duties under a variety of conditions including time and/or resource constraints
- Ability to self-assess knowledge and nursing skill, and continuously develop clinical expertise through Neighborcare Health and community-based Continuing Education
- Preferred for this job (List skills, knowledge, and abilities preferred for this job):
- Skills in Motivational Interviewing and application of a harm reduction model
- Knowledge of unique health needs of specific patient populations pertinent to the role/site
- Knowledge of community resources
- Completion of an accredited RN program
- Valid Washington State Registered Nurse license
- BLS certificate
- 2 years RN experience in a primary care, hospital and/or home care setting or comparable social service setting
Preferred Skills:
- BSN desirable
- Board Certification in applicable specialty areas
- 3 years RN experience in a primary care, hospital and/or home care setting or comparable social service setting
- Prior experience in care management, transitions of care management, and/or discharge planning
Since 1968, Neighborcare Health has been removing barriers to health care for our neighbors. We believe everyone deserves a place to call their health care home, where a team of medical, dental and mental health professionals work in collaboration with each patient to develop a personal health improvement plan.
We are one of the largest providers of primary medical, dental and behavioral health care services in the Seattle area serving low-income and uninsured families and individuals, seniors on fixed incomes, immigrants, and people experiencing homelessness. Each year we care for nearly 60,000 patients at our nearly 30 non-profit medical, dental and school-based clinics. We ask everyone to pay what they can, but no one is turned away due to inability to pay.
Our clinics are located in neighborhoods where health disparities are the greatest, and our care teams, who speak over 55 languages and dialects, are as diverse as our patients. No matter who you are, or where you come from, regardless of your insurance, income or immigration status, you are welcome at Neighborcare Health.
Learn more about us here.
The Full Job Description Is Available Upon Request
Full job description will be provided during the selection process.
Salary : $44 - $55