Nurse, Individualized Care
Core
Coordinate medical treatments, deliver patient education, and facilitate communication among patients, healthcare providers, and support systems to bridge gaps in care and promote continuity of treatment for individuals with complex chronic disease states, particularly cancer.
Role type
Senior Individualized Care Nurse Care Manager
Builds
Structured, patient-centered healthcare services and care management programs
Domain
Healthcare / Oncology / Chronic Disease Management
Required skills
Registered Nursing, chronic disease management, oncology care, care coordination, medication reconciliation, patient education, case management, quality improvement, discharge planning, telephonic care management, EHR proficiency
Preferred skills
Care Management experience, heavy oncology patient experience, bilingual skills
Technologies
Electronic Health Records (EHR), Microsoft Office, Excel
Responsibilities
Develop, implement, monitor, and evaluate clinical care plans; coordinate interdisciplinary case conferences; manage a caseload of 100-150 members; conduct telephonic care management including medication reconciliation and symptom management; assist with discharge planning and transitional care management; track and report member progress; facilitate patient follow-up visits and referrals to community services.
Seniority
Senior, hands-on IC