RN Case Manager - Remote​/Hybrid

Role Overview

The nurse case manager works within the context of a primary care medical home, from a team approach, and in continuous partnership with families and physicians to promote timely access to needed care, comprehension and continuity of care, and the enhancement of child and family wellbeing.

• Assisting patients' needs, developing a patient-centered care plan, monitoring outcomes, and coordinating interdisciplinary approaches and services mostly performed telephonic.
• Assist with or promote the identification of patients in the practice with special health care needs, add to registry and use to plan and monitor care.
• Assess child/patient and family needs and unmet needs, strengths and assets.
• Carry out care plans, evaluate effectiveness, monitor in a timely way and effect changes as needed; use age appropriate transition timetables for interventions within care plans.
• Initiate family contacts; create ongoing processes for families to determine and request the level of care coordination support they desire for their child/youth or family member at any given point in time.
• Build care relationships among family and team; support the primary caregiving role of the family.
• Demonstrate and apply knowledge of the philosophy/principles of comprehensive, community based, family-centered, developmentally appropriate, culturally sensitive care coordination services.
• Facilitate family access to medical home providers, staff and resources.
• Serve as the contact point, advocate and informational resource for family and community partners/payors.
• Research, find, and link resources, services and supports with/for the family; working in conjunction with community referral clerk.
• Educate, counsel, and support; provide developmentally appropriate anticipatory guidance; in a crisis, intervene or facilitate referrals appropriately.
• Cultivate and support primary care & subspecialty co-management with timely communication, inquiry, follow up and integration of information into the care plan.
• Coordinate efforts to gain family/youth feedback regarding their experiences of health care (focus groups, surveys, other means); participate in interventions which address family/youth articulated needs.
• Maintains confidentiality of all hospital and patient information at all times. Follows HIPAA regulations and policies.
• Regular and predictable attendance is an essential job function.

• Bachelor's degree in nursing preferred.
• Three years of relevant experience in community based primary care.
• Current Idaho RN license.
• Ability to work independently and make sound care decisions regarding established care plan.