Serves as the key point of contact to coordinate care with the patient, family, physicians and caregivers. Develops, documents, and coordinates the care plan. Assesses the existence of any psychosocial barriers to the plan of care and facilitates referrals to the clinical social worker for interventions as appropriate. Serves as a true patient advocate and a clinical resource for staff and physicians. Collaboratively works with caregivers to facilitate patient centered care and ensure a smooth transition across the continuum of care to achieve optimal patient satisfaction and wellness, improve care outcomes and efficient utilization of health services, and minimize denials of payment among the assigned patient population.
Required Education: Bachelor of Science in Nursing or bachelor's degree in a related field.If RN, effective 3/1/18 Bachelor of Science in Nursing OR enroll in a BSN or advanced degree program within 6 months AND obtain a BSN within 4 years of hire date into RN position. Previous signed BSN commitment letter OR grandfathering will be accepted between departments and Mission Health entities. Exemptions may be approved with CNO System Council approval.
Preferred Education: Master's in Nursing.
Required License/Certification: If RN, must have and maintain current licensure as registered nurse with the North Carolina Board of Nursing. eNLC (Enhanced Nurse License Compact) license may apply, licensee should confirm with NCBON Certificate: BLS Healthcare Provider for Level I & Level II Level II: Maintains nationally recognized certification in Case Management, such as ACM, CCM or ANA certification)
Preferred License/Certification: Level I: Maintains nationally recognized certification in Case Management, such as ACM, CCM or ANA certification)
Required Experience: Minimum of 3 years in nursing practice. Clinical knowledge, IT skills, effective interpersonal communication, critical thinking, successful problem-solving, ability to work autonomously, innovative thinking, resourceful at navigating community resources, team building and leadership.
Preferred Experience: Previous 5 years in nursing practice and 3 years care management. Community or ambulatory care management experience. Primary care clinical experience. Experience with inpatient discharge planning work. Motivational Interviewing and Intrinsic Health Coaching.
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