Cone Health
RN Care Manager: VBCI Population Health Weekends
Cone Health, Greensboro, North Carolina, us, 27497
Overview
RN Care Manager: VBCI Population Health Weekends at Cone Health – dedicated to value-based, patient-centered care that improves health outcomes across a diverse population. Responsibilities
Case Management/Care Coordination: Collaborate with interdisciplinary teams to develop, implement, and manage individualized care plans for patients, ensuring comprehensive, holistic support. Act as a liaison between patients, families, and healthcare providers to ensure continuity of care across settings. Patient Engagement: Educate and empower patients and their families about health conditions, treatment options, and self-management strategies. Assessment and Monitoring: Conduct thorough health assessments, identify barriers to care, and monitor patient progress to optimize outcomes, prevent admissions/readmissions, ED visits and/or exacerbations. Proactively assess needs, recognize early signs of potential complications, and intervene to ensure optimal outcomes. Regularly review and adjust care plans based on progress and outcomes. Quality Measurement: Assist with addressing HEDIS measures related to preventive care, chronic disease management, and care coordination, ensuring compliance with quality metrics. Care Gap Closure: Identify and address care gaps for patients, facilitating screenings, vaccinations, and follow-up appointments to improve health outcomes. Resource Management: Navigate and connect patients with community resources, support services, and specialty care as needed. Data Management: Utilize EHRs to track patient outcomes, document care activities, and ensure regulatory compliance. Quality Improvement: Participate in quality improvement initiatives focused on care gap closure, HEDIS performance, and patient satisfaction, contributing to best practices and improved outcomes. Advocacy: Serve as a patient advocate, incorporating patient preferences and values into care planning and decision-making. Reporting and Analysis: Leverage data and analytics to evaluate quality metrics, patient outcomes, and care coordination efforts for internal and external stakeholders. Clinical Expertise: Develop clinical expertise in specialty areas and/or chronic conditions; be a resource for population management (e.g., COPD, Diabetes, HF, Sepsis, ESRD, Sickle Cell, HTN). Identify and respond to health crises with timely interventions to prevent hospitalizations/ED visits. Qualifications
Education : Required: Graduate from Specialty Training Program - Nursing. Preferred: Bachelor of Science in Nursing (BSN). Experience : Required: Minimum of two years’ experience as an outpatient RN Care Manager (adult patients with complex medical needs and multiple chronic conditions) or a minimum of five years’ experience as an RN in an acute care and/or home care setting (adult patients). Preferred: Five+ years in Care Management with a Certification in a specialty area and a demonstrated history of serving high-risk adult/geriatric populations in outpatient settings. L icensure/Certification/Registry : Required: Active RN license in the practicing state. Preferred: RN licensure & Certified Case Manager (CCM). AHA Health Care Provider BLS (CPR) is optional at all Cone Campuses except Behavioral Health Hospital where it is required. EEO Notice
Equal Opportunity Employer At Cone Health, we strive to create a welcoming atmosphere that celebrates a diverse and unique workforce. We provide equal opportunities for employment regardless of race, religion, age, sex, sexual orientation, gender identity, veteran status, ethnicity, national origin, disability, color, or any other protected characteristic. Our hiring decisions are based on qualifications, skills, and performance. Note: This description contains typical elements considered necessary to perform the job; additional competencies may be required per department orientation.
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RN Care Manager: VBCI Population Health Weekends at Cone Health – dedicated to value-based, patient-centered care that improves health outcomes across a diverse population. Responsibilities
Case Management/Care Coordination: Collaborate with interdisciplinary teams to develop, implement, and manage individualized care plans for patients, ensuring comprehensive, holistic support. Act as a liaison between patients, families, and healthcare providers to ensure continuity of care across settings. Patient Engagement: Educate and empower patients and their families about health conditions, treatment options, and self-management strategies. Assessment and Monitoring: Conduct thorough health assessments, identify barriers to care, and monitor patient progress to optimize outcomes, prevent admissions/readmissions, ED visits and/or exacerbations. Proactively assess needs, recognize early signs of potential complications, and intervene to ensure optimal outcomes. Regularly review and adjust care plans based on progress and outcomes. Quality Measurement: Assist with addressing HEDIS measures related to preventive care, chronic disease management, and care coordination, ensuring compliance with quality metrics. Care Gap Closure: Identify and address care gaps for patients, facilitating screenings, vaccinations, and follow-up appointments to improve health outcomes. Resource Management: Navigate and connect patients with community resources, support services, and specialty care as needed. Data Management: Utilize EHRs to track patient outcomes, document care activities, and ensure regulatory compliance. Quality Improvement: Participate in quality improvement initiatives focused on care gap closure, HEDIS performance, and patient satisfaction, contributing to best practices and improved outcomes. Advocacy: Serve as a patient advocate, incorporating patient preferences and values into care planning and decision-making. Reporting and Analysis: Leverage data and analytics to evaluate quality metrics, patient outcomes, and care coordination efforts for internal and external stakeholders. Clinical Expertise: Develop clinical expertise in specialty areas and/or chronic conditions; be a resource for population management (e.g., COPD, Diabetes, HF, Sepsis, ESRD, Sickle Cell, HTN). Identify and respond to health crises with timely interventions to prevent hospitalizations/ED visits. Qualifications
Education : Required: Graduate from Specialty Training Program - Nursing. Preferred: Bachelor of Science in Nursing (BSN). Experience : Required: Minimum of two years’ experience as an outpatient RN Care Manager (adult patients with complex medical needs and multiple chronic conditions) or a minimum of five years’ experience as an RN in an acute care and/or home care setting (adult patients). Preferred: Five+ years in Care Management with a Certification in a specialty area and a demonstrated history of serving high-risk adult/geriatric populations in outpatient settings. L icensure/Certification/Registry : Required: Active RN license in the practicing state. Preferred: RN licensure & Certified Case Manager (CCM). AHA Health Care Provider BLS (CPR) is optional at all Cone Campuses except Behavioral Health Hospital where it is required. EEO Notice
Equal Opportunity Employer At Cone Health, we strive to create a welcoming atmosphere that celebrates a diverse and unique workforce. We provide equal opportunities for employment regardless of race, religion, age, sex, sexual orientation, gender identity, veteran status, ethnicity, national origin, disability, color, or any other protected characteristic. Our hiring decisions are based on qualifications, skills, and performance. Note: This description contains typical elements considered necessary to perform the job; additional competencies may be required per department orientation.
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