Care Manager – RN/LPN
Director of Clinical Operations
The RN/LPN is responsible for coordinating screening and providing care management to patients with identified complex chronic care needs. Addresses patient needs by providing care management and other resources. Provides guidance and leadership to other team
members, especially the RN/LPN care manager and to MA care coordinators and ensures the patients receive the best possible care.
Duties and Responsibilities
1. Identification and tracking of medium- and high-risk patients with care coordination and
- Comprehensive risk assessments.
- Integrated patient care plans focusing on disease self-management.
- Ongoing clinical assessment, monitoring and contact.
- Assessment of behavioral health needs, working with Behavioral Health Care Coordinators in
identifying community or internal/external agencies, resources and programs.
2. Promote clear communication among team members regarding patient care plans and progress.
a. Works closely with other team members around specific care management tasks and
b. Communicate clearly and collaborate closely with primary care providers.
c. Lead the multidisciplinary complex care management meetings.
3. Support in maintaining patient health and prevention of secondary disease complications by
providing education, counseling and support about healthy lifestyle changes and specific disease
4. Collaborate and participate in the selection, development and maintenance of patient
5. Participate in care transitions for medium and high risk patients, particularly from acute
inpatient and emergency department settings, back into the medical home.
6. Utilize standing orders and clinical orders for preventative and chronic disease management
within scope of clinical practice.
7. Preform medication review, reconciliation, education and coordination.
8. Participate in care team huddles and meetings.
9. Participate in the evaluation of the care management programs.
10. Make home visits if indicated.
11. Handle protected health information in a manner consistent with the Health Insurance
Portability and Accountability Act (HIPPA).
12. Participate in PrimeCare’s quality processes and activities as indicated.
13. Maintain current knowledge of regulatory agency requirements of compliance and ensures that
those standards are practice in the clinic.
14. Other duties and responsibilities as assigned.
1. Must be able to remain in a stationary position 50% of the time.
2. Must be able to move around the clinic site 50% of the time.
3. Constantly operates a computer, computer printer, copy machine, and telephone.
4. Occasionally positions self to maintain exertion of physical strength to move objects of 10
pounds from one level to another.
5. Must be able to transport from one site to another.
6. Must be able to cover other shifts as necessary.
7. Ability to move as needed to perform necessary nursing skills such as wound care, injections,
and other procedures.
Required Knowledge, Experience, or Licensure/Registration
1. RN/LPN-Active State of Illinois License
2. Bachelor’s Degree in nursing preferred
3. Two to three years of nursing experience
4. Prior experience in care management preferred