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RN - Care Manager Patient Aligned Care Team

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West Valley City, UT

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Summary Duties Demonstrates advanced clinical knowledge in assessing, planning, implementing, documenting, and evaluating care for a panel of patients across the continuum of care, recognizing the age related cognitive, physical, emotional, and chronological maturation needs of the adult and geriatric patient. Participates in chronic disease management for panel in collaboration with provider. Engages in Shared Medical Appointments (SMA), and/or RNCM visits. Utilizes the Primary Care Almanac and PACT Metrics to address population health management issues and improve Team processes. Triages and applies a collaborative team approach in identifying, analyzing, and resolving patient care problems. Assists in determining appropriate scheduling based on patient's clinical need. Right person, right place, right time Collaborates with ancillary team members and resources within the clinic to manage clinic access issues. This may include assisting other nursing staff with maintaining clinic flow. Promotes patient, family and team interactions, and problem solving by actively participating in interdisciplinary meetings to facilitate coordination and the achievement of identified goals. Collaborate with patients to assess and identify needs, issues, care goals, and resources for achieving desired outcomes post hospital recovery and health maintenance/wellness by effectively using Motivational Interviewing and TEACH techniques. Supports patient self-management by providing an ongoing relationship with the PACT with current information regarding all options, choices, and resources. Provides patient centered care while respecting patient's personal values, cultural, and belief system. Serves as a resource for patient and family rights, responsibilities, and decision-making information and processes. Maintains effective working relationships with professionals and support personnel within the medical center and the community. Applies critical thinking and analytical skills to identify barriers for optimal patient care delivery and utilizes processes improvement strategies to correct or improve current state. Utilizes creativity and innovation. Recommends and participates in interdisciplinary opportunities to improve patient care or clinical efficiency. As needed, provides back-up coverage for other team members and other PACT RNCM within the clinic. Work Schedule: Monday through Friday, Day Shift Financial Disclosure Report: Not required $51,212 $99,378 Job Details Application Open Date 7/13/2018

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