St. Mary's Good Samaritan RN Care Manager - Primary Care Lake Delton/Dells in Lake Delton, Wisconsin
The RN Care Manager – Primary Care will serve in an expanded nursing role to collaborate with Dean Clinic patients and their Care Teams to provide care across the continuum that ensures the delivery of quality, efficient, and cost-effective health care services to high risk patients. This will include assessing, planning, implementing, coordinating, monitoring and evaluating all options and services with the goal of optimizing the patient’s health status and their level of independence. This position will integrate evidence-based clinical guidelines, preventive guidelines, and protocols in the development of care plans developed in partnership with patients and/or caregivers and will educate patients and families to help them manage their health care needs. This position will facilitate communication, coordinate services, address barriers, and promote optimal allocation of resources while balancing clinical quality and cost management. The RN Care Manager – Primary Care will work in partnership with Dean Clinic care teams, SSM of Wisconsin hospital providers and staff, skilled nursing facilities, rehabilitation facilities, home health agencies, and other community agencies and health care organizations to optimize interventions.
State Licensure as a Registered Nurse in the State of Wisconsin
3-5 years of clinical nursing experience.
Strong written and verbal communication skills with the ability to influence and negotiate.
Demonstrated exceptional critical thinking skills with the ability to exercise independent and sound judgment in decision making, utilizing all relevant information.
Demonstrates ability to work within multidisciplinary teams and within a dynamic work environment
Demonstrates customer-focused service skills
Demonstrates high level time management, organizational skills, and priority setting.
Intermediate knowledge and skill of MS Office, including Excel, Word, and Outlook.
Ability to travel to various locations.
- Care or Case Management experience.
- Ambulatory experience
- Bachelor’s degree in Nursing (BSN)
Electronic Medical Record experience (EPIC preferred)
Experience in motivational interviewing
Essential Physical Functions:
The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
Uses assessment skills and appropriate risk assessment tools to identify patients with actual or potential health care needs that could benefit from care management.
Assesses the healthcare, educational and psychosocial needs of the patient and caregiver(s).
Designs a patient-centered plan of care that incorporates evidenced based guidelines and standards and fosters a team approach by working collaboratively with the patient, family, primary care provider, and other members of the care team to ensure coordination of services. Care goals should be specific, attainable, and measurable.
Monitors the effectiveness of interventions and reinforces and /or modifies the care plan.
Utilizes the nursing process: assessment, planning, intervention, and evaluation to monitor, detect, and anticipate early and subtle health status changes.
Coordinates care across the continuum (inpatient/outpatient/community) to assure appropriate utilization of clinical and community resources.
Promotes timely and effective communication based on individual and/or situational requirements and utilizes appropriate means to ensure adequate information flow and documentation.
Helps to maintain and update information on community resources.
Assures strong collegial working relationships with internal and external healthcare organizations and community resources.
Participates in the monitoring of quality and utilization metrics and recommends and participates in improvement efforts to refine the delivery of care to maximize clinical, quality, and fiscal outcomes.
Assists in the development and implementation of policies, protocols, standing orders, and quality assurance standards.
Adheres to department productivity standards
Maintains HIPAA standards and confidentiality of protected health information.
Records documentation for all care management activities in the electronic medical record in a timely and thorough manner
Performs other duties as required.
Organization: SSM Health Dean Medical Group
Primary Location: Wisconsin-Lake Delton-SSM Health Dean Medical Group Lake Delton
Shift: Day Job
Req ID: 16016435