RN Case Manager

This job was posted by : For more information, please see : The nurse case manager works within the context of a primary care medical home, from a team approach, and in continuous partnership with families and physicians to promote : timely access to needed care, comprehension and continuity of care, and the enhancement of child and family wellbeingEssential Job Functions : Assisting patients needs, developing a patient-centered care plan, monitoring outcomes, and coordinating interdisciplinary approaches and services mostly preformed telephonic.Assist with or promote the identification of patients in the practice with special health care needs, add to registry and use to plan and monitor care.Assess child / patient and family needs and unmet needs, strengths and assets.Carry out care plans, evaluate effectiveness, monitor in a timely way and effect changes as needed; use age appropriate transition timetables for interventions within care plans.Initiate family contacts; create ongoing processes for families to determine and request the level of care coordination support they desire for their child / youth or family member at any given point in time.Build care relationships among family and team; support the primary care-giving role of the family.Demonstrate and apply knowledge of the philosophy / principles of comprehensive, community based, family-centered, developmentally appropriate, culturally sensitive care coordination services.Facilitate family access to medical home providers, staff and resources.Serve as the contact point, advocate and informational resource for family and community partners / payers.Research, find, and link resources, services and supports with / for the family; working in conjunction with community referral clerk.Educate, counsel, and support; provide developmentally appropriate anticipatory guidance; in a crisis, intervene or facilitate referrals appropriately.Cultivate and support primary care & subspecialty co-management with timely communication, inquiry, follow up and integration of information into the care plan.Coordinate efforts to gain family / youth feedback regarding their experiences of health care (focus groups, surveys, other means); participate in interventions which address family / youth articulated needs.Maintains confidentiality of all hospital and patient information at all times. Follows HIPAA regulations and policies.Regular and predictable attendance is an essential job function.Minimum Qualifications : Bachelors degree in nursing preferred.Three years of relevant experience in community based primary care.Current Idaho RN licenseAbility to work independently and make sound care decision regarding established care plan.Excellent communication skills, both written and verbal.Ability to interact with physician as member of care team and patient advocate.Computer and EMR experience required.Joint Position, Full time, 40 hours per weekSMH is EOE