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RN - Nurse Care Manager - Physician Org Administration - Various Locations

Job ID: 950496
Facility: Vidant Medical Group
Location: Greenville, NC
FT/PT: Full-Time
Reg/Temp: Regular
Date Posted: Jun 30, 2021

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Job Description

Vidant Health

About Vidant Medical Group

Vidant Medical Group is a reputable and established multi-specialty physician group that provides superior care for the health and wellness needs of eastern North Carolina's patients. With 500 primary and specialty care providers in 90 locations, quality health care is never far from home.

Position Summary

The Panel Manager is responsible for care management for ambulatory patients. They work to manage patient preventive care needs, flag those at risk, improve quality of care and help bridge the gap between clinician and patient. The Panel Manager may also engage in traditional staff nurse work within the ambulatory setting.

  • Manage/Coordinate care of ACO, Medicaid, Uninsured, and MedCost population within the clinic under the direction of the providers
  • Aligns efforts and patient care priorities with system care management leadership goals and objectives
  • Serves as the direct practice level link for execution of tactics identified by system care management leaders
  • Act as liaison/bridge between patient, care manager, clinical team, provider, and stakeholder
  • Primarily responsible for ensuring providers and practice team members receive communication about care management/population health activities, goals, objectives, and outcomes
  • Ensure all stable ACO, Medicaid, MedCost, and Uninsured patients are seen by the provider at least once per year (or more if required) to ensure appropriate clinical care, documentation of conditions, risks, appropriate attribution, and HCC coding
  • Monitors ACO, Medicaid, MedCost, Payor Pay for Performance, and other quality outcomes at the practice and provider panel level and develops improvement plans to reach goals
  • Reviews reports and data to identify patients with care gaps and personally reaches out to schedule patients with the provider, health coach, annual wellness nurse, and/or other care management resources
  • Prepares charts in advance to ensure successful completion of clinical care related to ACO, Medicaid, and MedCost patients. Leads daily huddle to ensure alignment of practice resources and daily plans.
  • Review the Medicaid patient list and reconcile with the PHP monthly
  • Ensure new patients are identified and scheduled with a provider to initiate care
  • Direct link with Access East Care Management team for Transformation
  • Collaborate with the health coach or central care management team to ensure scheduling alignment of coordinating for care such as reducing emergency room utilization and post discharge follow up appointments (ie, high risk HF patient seen 3-5 days post discharge vs moderate risk seen within 14 days)
  • Ensure that post-hospitalized patients are seen within the necessary timeframe and that the visit is completed with the necessary documentation to bill appropriately, including HCC coding
  • Reviews data across providers in the practice to determine cost and utilization opportunities
  • Work with performance improvement team to report on and analyze data and will implement workflow changes needed to close gaps in care
  • Be the practice contact with Access East Care Management for patient centered medical home to ensure processes are adopted and progress made toward goals for NCQA recognition
  • Ensures planned visits are scheduled and followed up with appropriate team member (i.e.-Medicare annual wellness visits, high-risk patients such as those on Coumadin, chronic disease follow-ups) Identifies and improves throughput issues that impact patient access
  • Document appropriately in the medical record to communicate effectively with the provider
  • Knowledgeable of National Patient Safety Goals and practice in a manner which supports these efforts
  • Understand basic coding principles to include CPT, ICD 9 & 10, HCPCS, SNOMEDS and LOINC
  • Works directly in the office nurse role often enough to maintain direct patient care skills for the purpose of program alignment
  • Performs other duties as assigned

Minimum Requirements

  • Registered Nurse required
  • Graduate of approved School of Nursing and holds a current license to practice in the state of North Carolina
  • American Heart Association BLS Certification required

Preferred Requirements

  • BSN Preferred
  • Proficiency in Excel
  • Data analytics foundational knowledge preferred

Other Information

  • Positions will be embeded in VMG primary care clinics
  • Monday through Friday, 8:00 to 5:00 pm
  • Filling positions in Kinston, Tarboro, Washington, Edenton, and Greenville

General Statement

It is the goal of Vidant Health and its entities to employ the most qualified individual who best matches the requirements for the vacant position.

Offers of employment are subject to successful completion of all pre-employment screenings, which may include an occupational health screening, criminal record check, education, reference, and licensure verification.

We value diversity and are proud to be an equal opportunity employer.   Decisions of employment are made based on business needs, job requirements and applicant’s qualifications without regard to race, color, religion, gender, national origin, disability status, protected veteran status, genetic information and testing, family and medical leave, sexual orientation, gender identity or expression or any other status protected by law. We prohibit retaliation against individuals who bring forth any complaint, orally or in writing, to the employer, or against any individuals who assist or participate in the investigation of any complaint.

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