Nurse Care Manager

Organization Overview

The Central Florida Family Health Center, Inc. dba True Health is a private, not-for-profit federally qualified health center (FQHC) serving Central Florida since 1977. Our mission is to provide high-quality, comprehensive healthcare at a reasonable cost to everyone.

JOB SUMMARY

True Health’s Nurse Care Manager works with providers and clinical staff to facilitate the management of patient groups to improve health outcomes. The Nurse Care Manager fosters patient engagement and adherence to the care plan to achieve evidence-based clinical objectives and goals specific to their conditions and preventative health measures. The Nurse Care Manager may also be assigned to work on select clinical projects to reduce health disparities and improve health outcomes.

The Nurse Care Manager will be assigned to the HIV/PREP Patient Program and Mediation Assisted Therapy (MAT) Patient Program.

DISCLAIMER: This is a grant funded position. Continuation of employment depends upon grant funding, restrictions for the position, performance and/or organizational needs.

KEY RESPONSIBILITIES

• Works collaboratively with other members of the healthcare team in coordination of the patient’s care.
• Connects patients to relevant community resources as required, with the goal to increase satisfaction, patient health, and well-being and reduce healthcare costs.
• Guides the delegation of responsibilities to the appropriate staff member to meet the patient's needs. Ensure services comply with professional standards, state and federal regulatory requirements.
• Provides education for patients, families, and other members of the healthcare team.
• Acts as a liaison between patients, consulting physicians, referring physicians or outside agencies to coordinate patient appointments, admission, or surgery. Coordinates the exchange of information either written or verbal before and after patients are seen.
• Assist patients and family members with concern and empathy.
• Attend and participate in workgroups, program meetings and other associated meetings as scheduled.
• Perform patient outreach and schedule appointments as needed.
• Identify opportunities for gap closure on metrics tracked through the patient program and other quality initiatives.
• Assist with data mining and initiatives.
• Document accurately and promptly in the electronic medical record (EMR)
• Help maintain efficient patient flow through communication with healthcare teams.
• Answer telephone and return messages in a timely manner (within 48 hours).
• Monitor desktop and send patient letters/correspondence as applicable.
• Answer patient questions as needed within scope of practice.
• Respond to life-saving situations based on nursing standards, policies, procedures, and protocols within the scope of nursing practice.
• Educate the patient, family or caregiver, and members of the healthcare delivery team about treatment options, community resources, insurance benefits, psychosocial concerns, care coordination, etc., so that timely and informed decisions can be made.
• Assist the patient in safely transitioning care to the next most appropriate level.
• Strive to promote patient self-advocacy and self-determination.
• Ensure timely and accurate documentation in patients’ charts.
• Assist with tracking of referrals as necessary, ensuring documentation is current with necessary updates from patients and referral providers.
• This position will be tied to grants as assigned.
• Other duties as assigned

Essential Functions

• Problem Solving
• Project Management
• Customer Service
• Verbal Communication
• Written Communication
• Professional Judgement
• Planning/Organizing
• Quality Control
• Adaptability
• Initiative
• Administration/Operations

MINIMUM QUALIFICATIONS

• Education:

• High School Diploma or equivalent
• Current, active and in good standing Registered Nurse license
• Current CPR certification
• 1-year experience in population health and patient education is preferred

• 
  Experience:

• Experience in telephone medical triage along with knowledge of the referral process and medication refill requests
• Knowledge of adult and pediatric primary healthcare
• Excellent assessment skills
• Ability to make calls to other departments as needed
• Understand and strive to maintain teamwork with a positive attitude and eagerness to learn
• Ability to communicate effectively with healthcare teams
• Ability to work under pressure
• Computer competency
• Microsoft suite
• Telephone manners and excellent verbal communication
• Ability to work well with people from diverse backgrounds and cultures.

• 
  Criminal Background Clearance:
  • True Health is a Health Center Program grantee under 42 U.S.C. 254b, a deemed Public Health Service employee under 42 U.S.C. 233(g)-(n), and partners with agencies that require criminal background checks. True Health has established policies and procedures that may influence the overall employment process, hiring, and “just cause” for the termination of employees. An employee’s career could be shortened if there is a violation of any policies and procedures.

Prohibited criminal behavior is defined in Florida Statute (F.S.) 408.809. Any employee arrested for any offense outlined in the F.S.408.809 will be immediately suspended and remain suspended until the charges are disposed of in court. The employee will be terminated for an arrest or conviction of any violation listed above.

DRUG/ALCOHOL SCREENINGS

A post-offer drug and alcohol screen is a requirement for employment. Failure to successfully pass the drug/alcohol screen will be cause for the offer to be rescinded. Employees are subject to random drug/alcohol screenings throughout the duration of their employment with True Health. If an employee fails to pass the drug/alcohol screening, then this shall become grounds for discipline up to and including immediate termination.

WORK ENVIRONMENT

• The employee is subject to prolonged periods of sitting at a desk and working on a computer.
• The employee is subject to perform repetitive hand and wrist motions.
• The employee is frequently required to stand, walk, talk, and hear.
• The employee is occasionally required to use hands to handle or feel objects, reach with hands and arms, stoop, kneel, crouch, and move or lift up to twenty-five (25) pounds.
• The employee is required to use close vision, peripheral vision, depth perception, and adjust focus.
• A reasonable accommodation may be made to enable individuals with disabilities to perform the essential functions.

WORKING CONDITIONS

The employee will work as the needs of the operation require. Normal work days and hours are Monday through Thursday, 8am – 6pm and Fridays, 8am – 12pm; however, there will be times when the employee will need to come in or work on “off hours” or “off days” to meet the needs of the position.

CORE COMPETENCIES

Mission-Focused: Commits to and embraces True Health’s mission to enable access to care for uninsured and underinsured individuals.

Relationship-Oriented: Understands that people come before process and is essential in cultivating and managing relationships toward a common goal.

Collaborator: Understands the roles and contributions of all sectors of the organization and can mobilize resources (financial and human) through meaningful engagement.

Results-Driven: Dedicated to shared and measurable goals for the common good; creating, resourcing, scaling, and leveraging strategies and innovations for broad investment and community impact.

Brand Steward: Steward of True Health’s brand and understands his/her role in growing and protecting the reputation and results of the greater organization.

Visionary: Confronts the complex realities of the environment and simultaneously maintains faith in a different and better future, providing purpose, direction, and motivation.

Team-Builder: Fosters commitment, trust, and collaboration among internal and external stakeholders.

Business Acumen: Possesses a high-level of broad business and management skills and contributes to generating financial support for the organization.

Network-Oriented: Values the power of networks; strives to leverage True Health’s breadth of community presence, relationships, and strategy.

SELECTION GUIDELINES

The job description does not constitute an employment agreement between the employer and employee and is subject to change by the employer as the needs of the employer and requirements of the job change.