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RN Care Manager (1.0 FTE)Billings Clinic (BILLINGS CLINIC HOSPITAL)req12065Shift: Day, Evening, WeekendsEmployment Status: Full-Time (.75 or greater)Hours per Pay Period: 1.00 = 80 hours every two weeks (Non-Exempt)Starting Wage DOE: $38.96 - 48.71

Under the direction of department leadership, the RN Care Manager provides services consisting of comprehensive care management, care coordination and care continuing care services. Accountable for a designated patient caseload/population and plans effectively in order to meet patient needs. Supports providers and the multidisciplinary in facilitating patient care. Strives to enhance the quality of clinical outcomes and patient satisfaction while managing the cost of care.

Essential Job FunctionsAssessment * Conducts initial and ongoing assessments and chart reviews of each assigned patient to identify potential and or actual barriers and care needs. * Proactively screens and assesses the acuity and transitional needs of each assigned patient. * Engages and collaborates with patients, support systems and the multidisciplinary/healthcare team to establish a plan of care that addresses the mutually identified needs of the patient.Interventions and Care Coordination* Demonstrates the ability to interpret clinical information and understand health care treatment and systems. * Supports patients to ensure they can function to the best of their ability and maintain optimal health related to their medical condition(s). Identifies and addresses gaps in knowledge/understanding/education related to disease management. * Participates in the patient's plan of care by interacting/collaborating with patients, support systems, healthcare professionals and community and state agencies. Serves as a liaison between hospital, clinic and community agencies to facilitate the exchange of clinical and referral information. * Identifies high-risk patients through risk stratification tools and ongoing assessments including ED utilization and hospitalizations to address the medical/psychosocial/financial needs of patients and their support systems in both hospital and ambulatory settings. * Reinforces goals of care and treatment plans with patients and support systems in order to enhance patient and support system engagement. * Coordinates care conferences to support effective communication as needed. * Helps navigate the patient throughout the continuum of care. * Effectively collaborates and coordinates care with the Social Services Care Manager. * Maintains current knowledge of community resources and ancillary clinical services to meet the needs of hospital, clinic and regional customers. * Provides information about available resources to patients and their support systems. * Partners with the multidisciplinary/healthcare team and the Social Services Care Manager to