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Company: Santa Barbara Neighborhood Clinics
Location: Goleta
Posted on: September 15, 2022

Job Description:

SUMMARY: The Care Management position provides nurse triage services and health advice for SBNC patients in person, over the phone and via the patient portal. This position is an integral part of the Patient Centered Medical Home (PCMH). The RN will support chronic disease management efforts to support optimal patient outcomes. This position is not remote. ESSENTIAL DUTIES AND RESPONSIBILITIES - CALL CENTER TRIAGE: Elicits history of present illness and pertinent past medical history to formulate nursing assessment and plan for phone triage Uses protocol, clinical judgment, and experience to designate an appropriate disposition for patients calling in for medical advice that might include home care advice, office appointment, urgent care or Emergency Department Evaluation Documents subjective and objective information as well as a patient plan for each phone triage Coordinates follow-up care for patients with recent Emergency Department visits or hospitalizations Sends medication refills per clinic protocol ESSENTIAL DUTIES AND RESPONSIBILITIES - CASE MANAGEMENT: Reviews and follows up on Emergency Department and Hospital discharge summaries to facilitate coordination of transition to home Utilizes health coaching skills and encourages patient activation and self-management Maintains accurate charting and registry of all patients served under case management Help patients manage medications accurately and safely. RN is authorized to remove and update medications with Provider input. Participates in intensive outpatient case management of medically or psychosocially complex patients; visits may take place within the home. Provides health education and formulates care plans for patients and families; and support with chronic illness e.g. diabetes, asthma, heart failure, obesity, etc. ESSENTIAL DUTIES AND RESPONSIBILITIES - PANEL MANAGEMENT: Panel management is an organized, population-based, data driven multi disciplinary team approach to quality patient care Utilizes a disease registry to identify patients' unmet care needs, to gather summary information for care interventions, and to communicate with patients Uses health coaching techniques and standing orders along with patient outreach and community resources to improve patient engagement and ultimately improve patient outcomes. Designs, run and reviews patient reports for improved opportunities in care. Works as a team with other clinic staff to develop, maintain, and revise workflows to support improvements in missed care opportunities. The above statements are intended to describe the general nature and level of work being performed by most people assigned to this job. They are not intended to be an exhaustive list of all responsibilities, duties, and requirements. The omission of specific statements of duties does not exclude them from the position if the work is similar, related or it is a logical assignment to the position. The employee is expected to perform other duties necessary for the effective operation of the department. MINIMUM REQUIREMENTS/QUALIFICATIONS: Qualifications: Current CA RN License in good standing Current AHA CPR Certification Bilingual in English/Spanish Education: Associate or BA/BS Degree Experience: Five (plus) years of direct patient case experience; community health and/or triage experience Desired Skills and Abilities: Make quick and accurate assessments Write accurate and complete documentation Excellent Communication skills (written and verbal) Strong Critical-thinking skills Good history-taking skills Excellent Interpersonal communication Strong enthusiasm and willingness to pitch in whenever needed Good organizational skills Functions well in a high-stress environment Physical Demands: May be required to lift objects weighing up to 25 pounds. Sitting in normal seated position for extended periods of time. Reaching by extending hand(s) or arm(s) in any direction. Finger dexterity required to manipulate objects with fingers rather than whole hand(s) or arm(s), for example using a keyboard. The physical demands described above are representative of those that must be met by an employee to successfully perform the essential function of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions of this job unless providing such accommodations would result in undue hardship for the SBNC. Employment Type: Full Time Years Experience: 3 - 5 years Bonus/Commission: No

Keywords: Santa Barbara Neighborhood Clinics, Santa Barbara , RN, Healthcare , Goleta, California

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