Care Management RN
Company: Meritage Medical Network
Posted on: June 20, 2022
General Summary: The Care Management RN (DCE) manages defined
populations by using a collaborative process of assessment,
planning, implementation, and evaluation, to engage, educate, and
promote/influence beneficiary decisions related to achieving and
maintaining optimal health status in the Outpatient setting. The
Care Management RN (DCE) uses a combination of proactive telephone
calls, hospital, MD office, and home visits to beneficiaries who
are enrolled in Meritage's medical and wellness programs. This
position is responsible for developing and maintaining ongoing
supportive relationships with all members of the Care Management
Team and beneficiaries. Principal Accountabilities:
- Reaches out to patients identified as appropriate to provide
information and education in order to deepen their understanding of
their medical condition and to guide the patient in self-management
of the chronic disease.
- Emphasizes the value of health education and behavior
- Participates in all aspects of the Care Transitions
- Actively participates in the Care Team to improve/maintain
positive healthcare outcomes and care transitions.
- Works in collaboration with the individual patient and his/her
- Supports the Primary Care Physicians and their office
- Applies the standard elements of assessment, planning,
implementation, coordination, monitoring, and evaluation and will
use state-of-art information tools.
- Is highly organized, effective at managing her/his time, and is
skilled in the use of computers and multiple software systems.
- Remains objective in relationships with patients, families, and
physicians and promotes a team approach by encouraging
communication among all members of the care team.
- Coordinates care among multiple treating physicians including
specialists, primary care, hospitalists, and behavioral health
care, as necessary.
- Performs other clinical and related administrative duties as
assigned to support the organization's operational needs.
- Current California RN License with no restrictions and a
minimum of 5 years clinical experience, previous case/care
management experience is preferred.
- BSN preferred.
- Coleman model trained is a plus.
- Direct Contracting Entity (DCE) and Accountable Care
Organization (ACO) experience desired. Requirements:
- Familiarity with data collection and methods of analyzing and
reporting data, metrics, and related information pertaining to
clinical health programs.
- Professional written and verbal communication skills.
- Ability to function effectively in a team with patients,
families, physicians, MD office, and other Meritage departments and
- Treats others in a respectful, kind, and patient manner.
- Demonstrates sound clinical judgment and critical thinking in
accordance with the California Nurse Practice Act.
- Self-motivated, able to ask for assistance, and adapts easily
- Has a strong sense of accountability for work performed and in
- Knowledgeable about the available health care and community
resources for the populations managed.
- Understanding of family dynamics and the influence of cultural
and spiritual values in health care.
- Current valid driver's license and reliable transportation with
the required level of automobile liability insurance coverage
Keywords: Meritage Medical Network, Novato , Care Management RN, Healthcare , Novato, California
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