Nurse Care Manager

  • $85,000.00 - $100,000.00/year
  • Job Title
    Nurse Care Manager (RN)

    Job Description
    In this role, you will be part of the team at our founding clinical location, a primary care practice that in many respects looks and feels more like a community center than a doctor’s office, providing direct services to members, who face economic and social challenges in addition to having mental and physical health needs, through our innovative care model. At our core, our care model is focused on meeting people where they are, both physically and emotionally. Given this, your work will frequently take you out into the field and surrounding community to provide care in settings that work best for our members.

    As an RN Care Manager, you will work with a panel of members to improve their health holistically. You will support members when they leave the hospital, receive new diagnoses, are preparing for a procedure, are managing their chronic illnesses, are in pain, or when they need additional education. You will provide a necessary bridge to specialty care, home care services, and other facility services. Additionally, you will provide clinical support to our large team of Community Health Partners, who will serve as patients’ main point-of-contact and coordinator. You will work alongside and will be supported by, a care team associated with each member, whose work is focused around a Member Action Plan (MAP).

    Required Skills and Experience
    • You have a current, unrestricted NYS RN license
    • You have 3+ years of experience providing clinical services to Adult and Geriatric individuals with co-occurring chronic medical and behavioral health conditions
    • Willing to work a full-time 40 hour work week, Monday-Friday with Saturday Rotation
    • Familiarity and willing to travel within Brooklyn neighborhoods (home-based member visits) and it’s Healthcare systems (hospitals and rehab centers)
    • Experience as an active participant in continuous quality improvement projects within a provider setting
    • Possess exceptional triage, coordination and clinical assessment skills
    • Phenomenal communicator; you approach care interactions with warmth and thoughtfulness
    • Demonstrated the ability to affect change, and have been effective in helping a member or patient adapt new habits or change behaviors
    • Excited about how technology can support your work and help drive the ongoing evaluation toward new and better care
    • Independent self-starter, a leader, and a strategic thinker who is excited about the big picture of whole community health, and the ongoing evaluation and iteration of our care model

    (Nice to have)
    • Experience working collaboratively with an interdisciplinary care team, and specifically working alongside community health workers or care coordination staff.
    • Experience in home care, hospice, acute care, and/or care management.
    • Multi-lingual (Spanish, French Creole)
    • Bachelor’s degree preferred
    • Unrestricted NYS Driver’s License and Car
    • Care Management Certification (CCM)

    What You Need to Know
    - Follow a panel of Adult and Geriatric members to provide, nursing clinical support, including transitional care, health maintenance, medication reconciliation, chronic disease management and co-occurring psychiatric disorders
    - Meet with members in their homes, neighborhoods, and within the healthcare system
    - Assess in-home safety and risks and implement evidence-based interventions and protocols for complex chronic conditions
    - Utilize critical thinking skills and excellent communication skills to manage complex clinical issues utilizing assessment skills and protocols
    - Leverage strong time management skills to ensure that we make the most impactful judgement calls as we care for a full panel of members, and juggle competing priorities throughout the day

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