Overview
We are seeking a dedicated and highly skilled Health Home Registered Nurse Case Manager to join our multidisciplinary healthcare team. This vital role involves coordinating comprehensive, patient-centered care for individuals with complex health needs, ensuring seamless integration across various healthcare services. The ideal candidate will possess extensive clinical expertise, including critical care, hospital medicine, and outpatient experience, along with a strong commitment to improving patient outcomes through effective case management and discharge planning. This position offers an opportunity to make a meaningful impact by supporting vulnerable populations within a dynamic healthcare environment.
Responsibilities
- Conduct thorough patient assessments, including vital signs, medical history review, and physiological evaluations to determine individualized care plans.
- Coordinate and facilitate access to appropriate services across inpatient, outpatient, post-acute, and community settings, ensuring continuity of care.
- Develop and implement personalized discharge plans that incorporate medical records review, diagnostic evaluation results, and patient education to promote recovery and prevent readmission.
- Collaborate with multidisciplinary teams—including physicians, social workers, behavioral health specialists, and primary care providers—to optimize patient care strategies.
- Manage utilization review and utilization management processes to ensure appropriate resource use while adhering to HIPAA regulations and maintaining confidentiality of medical records.
- Provide patient service by educating patients and families on health conditions, medication management, and post-discharge instructions aligned with medical terminology standards.
- Monitor patient progress through ongoing case management activities such as intake assessments, hospital experience coordination, and outpatient follow-up visits.
- Maintain detailed documentation of all interactions in medical records systems while ensuring compliance with healthcare policies and procedures.
Experience
- Proven clinical experience in critical care environments such as ICU or Level II trauma centers; experience in Level I Trauma Centers is highly desirable.
- Extensive hospital medicine background with familiarity in emergency medicine settings including emergency room experience.
- Strong knowledge of infectious disease care, geriatrics, behavioral health issues, and medical-surgical nursing practices.
- Demonstrated expertise in discharge planning, post-acute care coordination, outpatient clinic operations, and inpatient case management.
- Familiarity with managed care principles, utilization management protocols, diagnostic evaluation procedures, and physiology fundamentals.
- Experience working within hospital environments that emphasize patient assessment accuracy and comprehensive patient service delivery.
- Ability to navigate complex healthcare systems involving outpatient clinics, inpatient units, and post-discharge follow-up while maintaining HIPAA compliance. Join us in delivering exceptional patient-centered care through expert case management that fosters recovery and enhances quality of life for diverse populations across healthcare settings!
Benefits:
- 401(k)
- Continuing education credits
- Dental insurance
- Disability insurance
- Flexible schedule
- Health insurance
- Life insurance
- Mileage reimbursement
- Paid time off
- Vision insurance
License/Certification:
Work Location: On the road
