Registered Nurse (2993)

Job DetailsJob Location: CVBC - Care Management - Irving - Irving, TX 75062Education Level: Associates DegreeJob Category: Other PositionsUS Heart and Vascular is seeking a Remote Registered Nurse Care Manager to join our Value Based Care Management team. M-F No weekends!!  Position Summary:  The Care Manager will perform telephonic Chronic Care Management, Principal Care Management, Remote Patient Monitoring and Transitional Care Management services to coordinate care for patients with chronic cardiovascular diseases and manage their post-acute care.    Responsibilities & Duties: Under the general guidance of nurse manager, practice physicians and advanced practice providers, the RN is primarily responsible for the following:   Outreaching referred and eligible patients to introduce care management services, obtain verbal consent for enrollment, and document in EHR per standard operating procedures   Make outgoing calls to patients to assist patients in managing their chronic diseases - including education about their conditions and treatment regimens, medication management, appointment management    Coordinates care across the continuum for patients with chronic cardiovascular conditions in collaboration with primary cardiologist, advanced practice providers, and other members of the multidisciplinary team within outpatient clinic setting   Assesses patient health and SDOH need, documenting and implementing care plans that optimize health outcomes  Serves as an important liaison for the interdisciplinary team and community organizations inclusive of other inpatient and outpatient care delivery organizations  Provide patient-and-family-centered-care in the outpatient setting and telehealth setting, including triaging calls and patient messages in the EHR  Provides patient and caregiver education related to health conditions, patient care, transitions of care, and ongoing chronic care management  Evaluates remote patient monitoring technology, diagnostics, and laboratory results to engage advanced practice provider for appropriate patient care and interventions  Ensures all CMS documentation and billing guidelines are adhered to in EHR   Requirements:  Requires excellent clinical, communication and organizational skills  Requires multitasking and critical analysis  Must be able to function independently within the limits of the position   Ability to function in a team environment  Demonstrate knowledge and competence in care management inclusive of transitional care management and complex care management  Demonstrate knowledge and competence in basic cardiovascular technology, i.e., EKG, patient assessment and management of care, labs/hospital test results  Strong understanding of population health concepts and clinical documentation requirements  Able to demonstrate interpersonal skills to be approachable and understandable to patients, families, and care team members   Minimum of an associate's degree in nursing; graduate of an accredited nursing program.  Currently licensed to practice as registered nurse with a compact license or licensure for Alabama, Arizona, Kansas, Louisiana, Georgia  and Texas   Current BLS for Healthcare Providers certification    Qualifications