Care Management Nurse - IN-PERSON/ON-SITE

POSITION SUMMARY 

This position serves the North Olympic Healthcare Network (NOHN) patients by coordinating care management and facilitating patient-centered, cost-effective care to specifically identified patient populations. The Care Mangement Nurse will customize and support coordination of the patient’s plan of care built around shared goals of the patient and their healthcare team. They will collaborate with providers and all members of the multi-disciplinary health care team to appropriately communicate, update, and implement patient centered care plans. The Care Management Nurse shares their medical expertise with patients through education and complex care coordination as well as with other members of the care team through participation in multidisciplinary patient case staffing meetings and activities.

The Care Management Nurse will be expected to be onsite. This is not a remote position.

ESSENTIAL JOB FUNCTIONS 

• ASSESSMENT AND PLANNING: Monitors condition and status of patients on assigned panels monthly or more frequently as indicated. Manages high-risk patient care populations as identified by the Quality Steering Committee, including management of patients with multiple co-morbidities and/or high risk for hospital readmission. Support patient self-management. Manages patient panels to promote patient care plan adherence, follow up, and appointment scheduling. 

• OUTCOME FACILITATION: Assists with specific patient needs or goals identified by the provider and makes interval contact with patients regarding clinical status updates between office visits when appropriate. 

• CARE COORDINATION: Works in cooperation with Patient Navigator to assist patients through the healthcare system by acting as a patient advocate. Facilitates access to healthcare and community resources. Facilitates continuity of patient care with external healthcare organizations and facilities, including hospital admission, discharge, and referrals from the primary care provider to specialty care providers when requested. 

• EDUCATION: Provides direct patient health education relevant to care plans. 

• DATA COLLECTION AND REPORTING: Assists in the collection, reporting, and analysis of clinical and demographic data relevant to patients assigned to registries. Evaluates clinical care and utilization of resources. 

• DOCUMENTATION: Documents patient care information in an accurate, concise, and timely manner. Competent in information management in both written and electronic documentation systems. 

• PARTICIPATION: Actively participates in staff meetings, and other meetings as appropriate. Actively participates in professional, departmental, and team-based education and competencies. Actively assists others in applying knowledge to the clinical and operational setting.  

• TEAM SUPPORT: Demonstrates skills essential to NOHN’s nursing team including triage and care coordination. Engages in cross coverage of nursing team as needed. 

• Promotes and models collaborative practice relationships with all health care professionals. Recognizes the role that the cultural diversity of patients and their families, employees, medical staff, volunteers, and community members play in achieving productive and positive relationships. Safeguards all (Electronic, written and oral) forms of confidential information as it relates to patients, their families, medical staff and employees. Is aware of and compliant with organizational policies regarding HIPPA, Fraud and Abuse, Conflict of Interest and the Code of Conduct. 

• Performs other related duties as required or requested by the CMO or CEO relevant to patient care. 

MISSION STATEMENT 

Our Mission is: The North Olympic Healthcare Network, a federally-qualified community health center, provides high-quality, full-spectrum Primary Care, Behavioral Health, and Oral Health services with competent professionals to meet the needs of North Olympic Peninsula. 

NOHN provides safe, effective, patient-centered, continuously measured and improved health care to every patient regardless of age, gender, race, creed, national origin, insurance status or ability to pay. 

The Nurse upholds and supports our mission statement by demonstrating the Employee Behavior Expectations as outlined below. 

ESSENTIAL JOB QUALIFICATIONS 

Education 

• Bachelor's degree as a Registered Nurse strongly preferred, current State of Washington RN licensure required. 

Experience  

• A minimum of three (3) years relevant clinical experience is required. Must have previous hands-on clinical experience and demonstrate clinical knowledge and competency. Must possess excellent computer and customer service skills with a caring approach to care. 

Licensure/Certification 

• Must possess valid clinical licensure as a Registered Nurse in the State of Washington, and BLS certification. 

Other Qualifications 

• Proven ability to effectively communicate, verbally, and in writing, with all levels of staff personnel. 

• Team-oriented and able to work collaboratively with staff. 

• Strong problem-solving and time-management skills. 

• Ability to work independently and cooperatively in a fast-paced, medical office environment with frequent interruptions, public contact, and occasional crisis situations. 

• Ability to maintain strict confidentiality with sensitive medical information and foster an ethical work environment. 

• Ability to carry out managerial responsibilities in accordance with NOHN policies and applicable laws. 

• Ability to understand and respond effectively and with sensitivity to special populations served by NOHN. Special populations include, but are not limited to, those defined by age, race, color, national origin or ancestry, ethnicity, family or marital status, sex, genetic information, disability, creed, religion, citizenship, socio-economic status, military or veteran status, or any other characteristic protected under applicable federal, state, or local law. 

• Regular attendance and punctuality are expected and required 

English Language 

• Must be able to read, write and speak English 

EMPLOYEE BEHAVIORAL EXPECTATIONS 

NOHN is a place where kindness and respect are guiding principles.  The following behaviors demonstrate our commitment to honoring those principles in our everyday work lives. 

Appearance 

• Maintain a professional personal appearance and abiding by the dress code at all times while working for and representing NOHN 

Attitude 

• Acknowledge clients, and maintain appropriate eye contact 

• Always be welcoming, kind, courteous, respectful and helpful to clients and co-workers alike 

• Express gratitude often 

Respect 

• Always treat patients with respect, kindness, and compassion 

• Always treat colleagues in a respectful manner 

• Celebrate and respect differences in culture, lifestyle, points of view, and belief systems 

Owner/Accountability 

• Act as an ambassador representing NOHN 

• Anticipate and consistently exceed customer/patient needs and expectations 

• Understand and willingly accept all appropriate job responsibilities 

• Demonstrate a proactive, positive approach to problem solving 

Communication 

• Always acknowledge patients and their family members using their preferred name 

• Keep patients and their families fully informed 

• Always maintain patient confidentiality and respect patient and co-worker privacy 

• Utilize kind and respectful telephone and email communication 

• Demonstrate positive and proactive communication skills, including active listening. Speak respectfully and actively participate in finding solutions that benefit everyone involved.