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Description

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Summary:

The Ambulatory Care Manager (RN) is responsible for assessment of the patient’s needs for community care support systems and development of a patient-centered plan of care. The Care Manager will collaborate with patients, their families/caregivers, providers, and interdisciplinary care team for overall care coordination to develop the plan of care and initiate and monitor services.

Responsibilities:

• Assesses and evaluates medical, psychosocial and social needs of patients and their families.

• Develops plan of care in collaboration with interdisciplinary care team, patients and their families/caregivers.

• Develops a self-management plan in collaboration with patient and family/caregiver to assist with identification of risk and appropriate interventions.

• Educates patients and their family/caregivers regarding disease processes, medication management, symptom exacerbation and appropriate site of care.

• Monitors patient status and progress towards meeting care plan goals and adjusts the care plan accordingly. Identifies problems and needs of the assigned client, strengths and weaknesses, available resources, and financial status relative to care needs.

• Assesses for Social Determinates of Health (SDOH) and any barriers to care and makes referrals to community resources as appropriate. Provides assistance with linkage to community resources to enhance client/family coping capacity.

• Prioritizes caseload according to need and available resources.

• Meets with patients face-to-face while in office for appointments or follow-up by phone. Travels between sites to meet with patients as necessary.

Other information:

Required

+ Must be licensed to practice as a Registered Nurse in North Carolina or one of compact states by the day of clinical care.

+ Three (3) years of experience working in a clinical capacity in an acute care, home health, or long-term care setting.

+ One (1) year of experience working as a Registered Nurse (RN)

+ Active Driver’s License and access to transportation

+ Excellent verbal and written communication skills.

+ Cultural competency and/or experience working with individuals with a wide range of backgrounds

+ Current Basic Life Support (BLS) certification

Preferred

+ 2 years of previous experience performing care management in an outpatient setting.

+ Experience with community resources and agencies.

Job Details

Legal Employer: Pardee - HCHC

Entity: Pardee UNC Health Care

Organization Unit: Blue MD Administration

Work Type: Full Time

Standard Hours Per Week: 40.00

Work Assignment Type: Hybrid

Work Schedule: Day Job

Location of Job: DR PARK

Exempt From Overtime: Exempt: No

Qualified applicants will be considered without regard to their race, color, religion, sex, sexual orientation, gender identity, national origin, disability, or status as a protected veteran.