Thundermist Health Center is currently seeking a full-time, 40 hour/week, RN Care Manager for our Woonsocket location. This position may be part-time for no more than two months before becoming full-time.
Provide comprehensive screening, assessment, care coordination services, disease education and self-management support to a caseload of moderate to high risk adults with complex chronic health conditions or post natal in a community primary care setting. Coordinate sick visits or additional services as needed.
1. Current State of Rhode Island RN license
2. Experience in community health setting , public health, chronic disease management, community nursing, case management preferred
3. Experience in working with primary care providers in practice setting to coordinate care and disease management.
4. Knowledge of disease management, case management, and chronic care principles
5. CPR certification strongly recommended
OR - any combination of education and experience that shall be substantially equivalent to the above qualifications
1. Moderate physical activity, walking, standing, stooping, and occasional lifting.
2. Potential exposure to blood-borne pathogens, infectious diseases i.e. respiratory (Tuberculosis), and bio-hazardous materials.
3. Manual dexterity for injections, computer use.
4. Organization skills, neatness; knowledge of safety and infection control standards of practice.
Work Schedule Demands:
As scheduled during hours of operation (inclusive of week-end and evening hours as assigned) with occasional unscheduled overtime.
1. Interpret technical medical terminology daily. Use all available methods of communication with patients, such as with interpreting, counseling, group discussion, written materials and visual aids.
2. Communicate and identify cultural, social and economical characteristics of the patient population served.
3. Document clearly and concisely in the medical record.
4. Assist with clinical audits; databases as assigned.
5. Work as a team member for performance improvement initiatives
6. Maintain confidentiality of information and communicate in a professional manner with patients, families other staff and outside contacts
7. Communicate effectively and work collaboratively with patients, providers, other members of the health care team, other disciplines and community agencies.
8. Demonstrate professionalism, leadership skills, triage skills, documentation skills, and teaching skills
Confidentiality of Information:
Full access to the patient’s medical record. Maintains confidentiality at all levels of patient interaction.
Significant Job Functions:
Manage a caseload of moderate to high risk adults with complex chronic health conditions or post natal mothers, in a community primary care setting.
1. Complete comprehensive physical, medical, and psychosocial assessment on all new program enrollees, including the SF-36 Health Status Survey and the Katz functional Assessment
2. Conduct a face-to-face interview ( home visit optional) in order to: assess baseline knowledge of conditions: determine patient strengths/ skills; identify patient’s support system and current community supports/agencies and providers; include patient’s identified needs and barriers
3. Establish care plan, goals, interventions, and contact schedule based on risk category and patient’s identified medical and social needs
4. Promote compliance with disease specific clinical outcomes by providing each individual with self management supports including:
a. Disease specific educational materials
b. Medical charts and side effects
c. Signs and symptoms to watch for and report to MD
d. Nutritional recommendations
e. Exercise and activity
f. Community supports, services and resources including current provider information such as Pharmacy, DME, and Home Care providers
g. How to communicate with your doctor
h. Care plan and treatment goals including self-management goals
5. Maintain standard precautions at all times
6. Maintain OSHA and HIPPA guidelines
7. Adhere to organizational policies and procedures
8. Maintain and sustain line of communication with supervisor, providers and other staff members
9. Actively participate in performance improvement activities to improve quality of care and safety to assure that the health care team meets and exceeds the established standards of practice and benchmarks