What are the responsibilities and job description for the RN, Transition/Outreach Manager position at Care New England?
Job Summary:
The Integra RN Transition/Outreach Manager collaborates with a multidisciplinary team, including physicians, nurses, hospital care coordinators, and social workers, to implement cost-effective, quality-focused management interventions aimed at achieving predetermined financial and clinical outcomes. This role is pivotal in managing high-risk, chronically ill patients by promoting education, self-management support, and timely healthcare delivery to optimize both quality and financial outcomes.
The Integra RN Transition/Outreach Manager plays a crucial role in patient outreach, coordinating care, and ensuring the quality of care through efficient resource utilization. The role also involves maintaining ongoing communication with patients, care coordinators, social workers, and physicians to provide access to appropriate community resources and support.
Duties and Responsibilities:
Applies Case Management principles to the chronic care/high risk patient population to ensure appropriate utilization of resources and level of care. This includes assessing, planning, implementing, coordinating, evaluating and collaborating with the interdisciplinary team, patients, families and community providers.
Assists in the facilitation of care management services for Integra ACO patients with Care Coordination who are identified for care management.
Assists in the facilitation of patient flow with Care Coordination by identifying barriers and working with the interdisciplinary care team to improve.
Assists in the identification of patients for Case Management and Social Service referrals during the review process.
Completes all documentation in a timely manner in Epic.
Acts as a resource to the care management team.
Engage in process improvement activities that are focused on efficient care delivery and promotes positive clinical and quality outcomes including reducing unnecessary admissions, readmission rates and flow metrics.
Protects and preserves patient confidentiality at all times.
Performs related duties as required.
Requirements:
Bachelors degree in nursing or equivalent. Minimum 5 years of related clinical acute care or case management experience
Active RI RN license
Case Management (preferred)
Care New England Health System (CNE) and its member institutions, Butler Hospital, Women & Infants Hospital, Kent Hospital, VNA of Care New England, Integra, The Providence Center, and Care New England Medical Group, and our Wellness Center, are trusted organizations fueling the latest advances in medical research, attracting the nations top specialty-trained doctors, and honing renowned services and innovative programs to engage in the important discussions people need to have about their health.
Americans with Disability Act Statement: External and internal applicants, as well as position incumbents who become disabled must be able to perform the essential job-specific functions either unaided or with the assistance of a reasonable accommodation, to be determined by the organization on a case-by-case basis.
EEOC Statement: Care New England is an equal opportunity employer. All applicants will be considered for employment without attention to race, color, religion, sex, sexual orientation, gender identity, national origin, veteran or disability status
Ethics Statement: Employee conducts himself/herself consistent with the ethical standards of the organization including, but not limited to hospital policy, mission, vision, and values.
