RN Care Manager

Medix is looking for a Registered Nurse Care Manager (Hybrid) to help us transform the way primary care is delivered and how patients are served. We are partnering with one of the national leader on the forefront of healthcare. We're creating care that's more accessible. Effective. Efficient. With solutions that are value-based, physician-driven and patient-centered. This position wil be a hybrid role (onsite/remote).

Schedule: Monday - Friday 8a-5p

Job description

RN Care Managers collaborate with PCPs, hospitalists, multidisciplinary Care Management team members and community agencies/services with the overall goal of improving health outcomes and reducing avoidable utilization for complex and high-risk patients. RN Care Managers provide wholistic assessments including the physical, mental, social, and spiritual needs of patients with complex medical conditions. Through shared decision making, RN Care Managers develop patient-centered care plans with both episodic and longitudinal interventions. These collaborative relationships assist in mitigating barriers to health, decrease unnecessary healthcare spend/cost, and reduce future utilization events.

Responsibilities

• Perform comprehensive assessments identifying risk factors and addressing barriers to care such as medication adherence, SDOH factors and health literacy
• Engage patients and their support systems at the point of care, assessing health and risk status and establishing patient centered care plansEmploy motivational interviewing skills to elicit optimal patient engagement and outcomes
• Provide early intervention related to condition/lifestyle management, medication adherence and address any unmet social determinants of health (SDOH) needsDevelop deep relationships with patients and their caregivers, serving as a partner to improved quality of life through admission and readmission avoidance
• Coordinate with inpatient and outpatient multi-disciplinary care teams to ensure a safe transition of care, including scheduling of timely PCP post-discharge follow up appointments
• Maintain consistent communication with the PCP related to patients admission, discharge and outpatient status
• Monitor patients as they transition from facilities to home, completing post-discharge follow up, medication reconciliation, reducing patients overall risk of readmission
• Complete timely documentation of clinical interventions in applicable care management and EMR systems

Requirements

• 3+ years of direct, clinical nursing experience
• Registered Nurse with an unincumbered license in the state of practice
• Care management experience in a primary care or inpatient setting preferred
• Comfort and efficiency with technology including Microsoft suite of products

For California Applicants:

We will consider for employment all qualified Applicants, including those with criminal histories, in a manner consistent with the requirements of applicable federal, state and local laws, including the City of Los Angeles' Fair Chance Initiative for Hiring Ordinance (FCIHO), Los Angeles Fair Chance Ordinance for Employers (ULAC), The San Francisco Fair Chance Ordinance (FCO) , and the California Fair Chance Act (CFCA).

This position is subject to a background check based on its job duties, which may include patient care, working with vulnerable populations, access to financial and confidential information, driving, working with heavy machinery, or working in a warehouse or laboratory environment. Due to these job duties, this position has a significant impact on the business operations and reputation, as well as the safety and well-being of individuals who may be cared for as part of the job position or who may interact with staff or clients.