Job Description:

Summary:

The Care Manager/Care Coordinator, BHMA provides transition of care, case management, coordination of care, remote patient monitoring and disease management support for high-risk patients and patients with chronic diseases. The RN will use strong interpersonal skills to collaborative with providers, team members, hospital coworkers, and families. He/she will act as a health coach with patients and assist them through coordination of care, wellness through prevention, support, encouragement and education.

The Care Manager will be responsible for assessing identified patients to determine their eligibility for care management enrollment. Upon enrollment, the Care Manager will conduct an initial assessment, establish patient-specific goals, develop a personalized care plan, and determine appropriate contact frequency with the goal of supporting patients in achieving effective self-management of their health. The Care Manager will manage a caseload of complex patients and will assign cases to LPN team members as needed. The Care Manager will be responsible for providing oversight for the LPN team members, ensuring NCQA guidelines are followed and met for the team and implementing Remote Patient Monitoring (RPM) protocols as needed for the team.

Requirements:

Bachelor’s degree in nursing. Minimum three years clinical experience required with chronic disease management preferred.

Experience with LPN oversight preferred.

Work Requirements:
Shift: Day
On Call: No
Weekends: No
Travel Required: No Travel

Location:
Ballad Health Medical Associates