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RN-Chronic Care Management

Canyonlands Community Health Care
Page, AZ Full Time
POSTED ON 3/4/2025
AVAILABLE BEFORE 5/4/2025

Description

Basic Function: 


This position assumes advocacy and accountability for an identified group of patients during all or part of  the continuum of care. Focuses on primary disease prevention and improving quality of care for chronically ill patients and  outreach to patients to be more engaged in their overall health and wellness through care planning and management.  Collaborates with the health care team members to identify appropriate utilization of resources. 




  

Canyonlands Healthcare is an Equal Opportunity Employer. Please contact HR at 928.645.9675 ext 2212. Applications are required and are available online at www.canyonlandschc.org/ Resumes may be attached to the application but will not be accepted in lieu of a completed application. Successful completion of a background check and drug screen are a prerequisite to employment. Applications are accepted until position is filled. 

Requirements

Essential Functions: 


1. Collaborates with health care staff responsible for patient care to develop, implement, monitor and evaluate appropriate  clinical care or other services to meet the needs of patient and coordinates all activities related to chronic care management.  

2. Plans for, ensures access to, and evaluates the effectiveness of care at the next level of care along the continuum of care.  

3. Ensures that areas of responsibility are operating in compliance, including documentation and records with all federal,  state, and regulatory agencies.  

4. With the primary care team, identifies patients to be case managed, assesses patient’s care requirements, modifies or  coordinates modification of patient care and intervenes, as necessary.  

5. Coordinates in the development and review of clinical pathway trends and shares with appropriate service and  management teams. 

6. Assist with monitoring of quality improvement elements including establishment of program measures and  implementation of action plans. 

7. Works directly with the Population Health Director and Community Health Workers to establish and implement outreach  tasks and patient centered engagement.  

8. Monitors trends and implements strategies to assist patient with accessing appropriate level of care.  

Salary : $73,585 - $103,020

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