SUMMARY:
The Enhanced Care Management RN serves as a clinical and operational leader for Enhanced Care Management (ECM) services, providing comprehensive care coordination for individuals with complex medical, behavioral health, and social needs. This role partners with providers, care teams, and community-based organizations to ensure members receive timely, whole-person care across the healthcare and social services continuum.
The Enhanced Care Management RN oversees daily ECM operations and provides direct supervision and clinical guidance to care management staff, including Registered Nurses, Licensed Vocational Nurses, and Community Health Workers. This position ensures ECM activities are delivered in alignment with program requirements, best practices, and quality standards, with a strong focus on addressing social determinants of health, reducing barriers to care, and improving patient outcomes.
The role involves engaging members through telephone, electronic, and face-to-face communication to complete comprehensive assessments, develop and monitor individualized care plans, coordinate services, and support self-management goals. The Enhanced Care Management RN collaborates closely with primary care providers, specialists, behavioral health teams, health plans, and community partners to ensure continuity of care and appropriate service utilization.
Key responsibilities include implementing and monitoring ECM workflows, maintaining disease and member registries, tracking quality and utilization metrics, ensuring accurate and timely documentation, and supporting compliant billing and reimbursement processes related to care management services. The Enhanced Care Management RN also plays an active role in performance reporting, staff education, and continuous quality improvement initiatives.
ESSENTIAL FUNCTIONS:
1. Utilizes the nursing process of assessment, nursing diagnosis, plan intervention and evaluation to ensure that resources of the Department are used to provide for patient’s care, comfort and safety. Prioritizes plans and organizes the delivery of comprehensive nursing care as provided by the healthcare team.
2. Collaborates with the Licensed Independent Practitioners to identify the medical management, patient goals and nursing interventions.
3. Demonstrates technical/clinical competence in providing appropriate nursing care or the department assigned. Can manage change with the workload. Initiates emergency measures, which require independent judgment and action.
4. Acts as an advocate for patient rights by initiating and maintaining confidentiality, privacy, safety, patient education and active collaboration with the healthcare team to promote the patient’s best interest.
5. Accountable for assignments and their completion within scheduled work hours. Maintains appropriate time records. Works independently with minimal supervision or direction.
6. Orientates new staff members as needed. Functions as a clinical resource to LVNs, Medical Assistants (I & II) and ancillary staff.
7. Supports, promotes and functions within the Clinic and unit policies and procedures and the Nurse Practice Act.
8. Demonstrates proficiency in managing resources and safely utilizing equipment. Actively contributes to cost control by managing time, resources and supplies effectively.
9. Administers and controls medications.
10. Attends a minimum of nine (75%) unit staff meetings annually to be successful. Accountable for reading minutes of monthly meetings. Participates in conferences and education programs, as required, and Quality Improvement activities and issues that monitor to improve care provided.
11. Assesses patients and patient populations need for case management within the health care continuum
12. assesses the multidimensional domains of: physical functioning, psychological functioning; social supports and financial resources
13. Conducts concurrent utilization activities according to established criteria and guidelines
14. Evaluates and collaborates with all members of the health care team to document patient status and variances, working toward achievement of patient goals/optimum quality and cost outcomes.
15. makes appropriate referrals using available community/regional resources
16. Implements plans appropriate for the individual
17. Complies with all managed care programs
18. Maintains complete and disciplined documentation of activities.
19. Reports monthly activities and data
OTHER RESPONSIBILITIES:
1. Assesses and cares for the geriatric patient with knowledge and clinical skills of the aging process.
2. Assesses and cares for the pediatric patient with knowledge and clinical skills of the growth and development process.
3. Maintains and demonstrates professional skills through self-development and participation in on-going hospital in-service education.
4. Maintains accountability for own practice and for aspects of nursing care delegated to peers, LVNs and other ancillary personnel.
5. Utilizes the chain of command in situations where resolutions for the issue exceeds ones’ authority.
6. Demonstrates knowledge and the ability to apply ethical and legal principles to practice.
7. Communication:
a. Clearly and accurately communicates pertinent aspects of the patient’s care to other members of the Patient Care team.
b. Documentation in patient records will be problem oriented and will provide relevant, factual and accurate information.
c. Documentation in the Patient Record will be legible at all times. Entries in the patient record will be dated, timed and signed with title.
8. Maintains positive and caring interpersonal relationships with patients, families and fellow employees.
9. Offers and accepts constructive criticism and incorporates suggestions into nursing practice.
10. Supports and promotes safety standards. Identifies risk situations and intervenes appropriately.
11. Demonstrates clinical competence by successful completion of the Annual certification of standardized procedures. Must have current knowledge of Universal Precautions as employee may have to deal with potential exposure to Blood-borne Pathogens.
12. Other duties as assigned from time to time.
SUPERVISORY RESPONSIBILITIES:
None
EDUCATION, KNOWLEDGE, SKILLS, ABILITIES, AND EXPERIENCE:
1. Knowledge of hospital and nursing policy and procedure and the function of other departments within the facility.
2. Previous clinical experience in a patient care setting with successful completion of orientation and training to the point of competence.
3. Bilingual (Spanish/English).
LICENSES AND CERTIFICATIONS:
1. Current licensure to practice registered nursing in the State of California.
2. Current CPR certification and ACLS certification is required.
AGE OF POPULATION SERVED:
Newborn Infant/Pediatric Adolescent Adult Geriatric X All No Patient Care
PHYSICAL REQUIREMENTS:
1. Manual dexterity with fine motor ability to operate and handle equipment used in the department.
2. Ability to hear the spoken word, auscultate for physical assessment skills and monitor alarms.
3. Ability to see written type with corrective lenses.
4. Ability to stand for up to several hours at a time.
5. Ability to climb stairs.
6. Able to perform tasks of lifting, turning, and transferring patients with assistance.
7. Sits, stands, bend, lifts, and moves intermittently during working hours.
