Nurse Care Manager-Primary Care; RN

• Department Kootenai Clinic - Family Medicine - CdA Ironwood

Responsible for managing patient populations with chronic illness and/or multiple co-morbidities.

Responsibilities:

• Works in coordination with primary care provider and collaborates with multiple care team members to serve as the point person to an empaneled patient population
• Assists in designing and implementing planned care interventions through a combination of evidence-based guidelines/pathways and individual care planning consistent with patient preferences and functional/lifestyle goals
• Assists in managing care for the identified patient population across the continuum of care
• Provides leadership and continuity of care guidance for patients with chronic diseases and/or complex disease states
• Engages patient and family to educate, counsel and coach related to patient’s diagnosis, pathology, medical and nursing treatment plans, discharge needs and health goals
• Uses the Nursing Process to identify potential or actual problems that could lead to an emergency/crisis situation and takes appropriate action to mitigate, including potential barriers to care
• Supports patient self-management utilizing patient activation activities
• Advocates for patients in all settings of car
• Keeps all members of the care team informed
• Updates plan of care in collaboration with the patient and care team members
• Seeks out new information that impacts care and ensures it is entered into the medical record and assessed by care team members; updates plan of care accordingly
• Maintains complete documentation of all critical and essential aspects of medical history and information in the patient’s record
• Performs all duties in a manner which promotes team concepts and reflects the mission, vision and values of Kootenai Health
• Performs other related duties as assigned
• Familiar with standard concepts, practices, and procedures within the field
• Relies on experience and judgment to plan and accomplish goals
• Regular and predictable attendance is an essential job function
• Competent to meet age specific needs of the unit assigned

Requirements and

Minimum Qualifications:

• State of Idaho Registered Nurse or licensure pending as documented by temporary licensure OR current RN licensure from a state participating in the "multistate privilege to practice" compact with Idaho.
• BSN or higher nursing degree required
• Certification in relevant nursing area preferred
• BCLS by a KH approved provider Previous experience in caring for chronic disease patients required.
• 3 years’ experience in clinical or community health settings preferred.
• Previous Care Coordination, Case Management or Home Health experience preferred.
• Knowledge of quality and financial outcomes of patient care processes preferred.
• Demonstrates evidence of essential leadership, communication, education, collaboration, and counseling skills.
• Proficient in communication technologies (email, cell phone, etc.).
• Effective organizational skills and demonstrates ability to maintain accurate notes and records.
• Previous experience with health IT systems and data reports preferred.
• Previous experience with mobilizing community resources, navigating patients through the healthcare continuum, and working with disparate populations preferred.
• Ability to identify and implement appropriate patient communication strategies and overcome accessibility barriers, as required

Working Conditions:

• Must be able to maintain a sitting position
• Typical equipment used in an office job
• Ability to lift up to 35 pounds
• Must be able to stoop, crouch or bend

About Kootenai Health:

Kootenai Health is a highly esteemed healthcare organization serving patients throughout northern Idaho and the Inland Northwest. We have been recognized with many accolades and distinctions, including being a Gallup Great Workplace, No. 1 Best Place to Work in Large Healthcare Organizations, and Magnet™ Status for Nursing Excellence. We pride ourselves on our outstanding reputation as an employer and a healthcare provider.

As your next employer, we are excited to offer you:

• Kootenai Health offers comprehensive medical plan options, including options for fully paid employer premiums for our full-time employees.…