Registered Nurse (RN) - Telemetry
HarmonyCares
Austin, TX

Telephonic Nurse Care Manager

Overview HarmonyCares is one of the nation's largest home-based primary care practices. HarmonyCares is a family of companies all dedicated to providing high-quality, coordinated health care in the home. This includes HarmonyCares, HarmonyCares Medical Group, HarmonyCares Home Health and HarmonyCares Hospice. Our Mission - To bring personalized, quality-based healthcare to the home of patients who have difficult accessing care. Our Shared Vision - Every patient deserves access to quality healthcare. Our Values - The way we care is our legacy. Every interaction counts. Go the extra mile. Empower and support each other. Why You Should Want to Work with Us Quarterly Bonuses Health, Dental, Vision, Disability & Life Insurance, and much more 401K Retirement Plan (with company match) Tuition, Professional License and Certification Reimbursement Paid Time Off, Holidays and Volunteer Time Paid Orientation and Training Day Time Hours (no holidays/weekends) Great Place to Work Certified Established in 11 states Largest home-based primary care practice in the US for over 28 years, making a huge impact in healthcare today! Responsibilities The Nurse Care Manager works closely with HarmonyCares Medical Group (HCMG) in home health care continuum and specialty services to maximize the health of the HCMG patients. This position will manage a caseload of high-risk patients where he/she is responsible for managing their care and barriers. These duties will include Transitional Care Management, Chronic Care Management of the HCMG patients. Essential Duties & Responsibilities Provides clinical coordination Prioritize patients based on the severity and urgency of their conditions. Triage is crucial in high acuity settings to ensure that the most critical cases receive immediate attention Demonstrate strong clinical skills, critical thinking abilities, and effective communication Prioritize nursing interventions based on the severity of the patient's condition Collaborate with the patient and multidisciplinary team to develop an individualized care plan based on the identified goals and needs and allocate tasks and interventions to the appropriate team members based on their experience Collaborates in patient care planning process to assess, monitor and evaluate options and services to meet health needs Implements a comprehensive clinical care management plan for each patient. Analyses variances from plan and initiates steps to resolve such variances Spend quality time with our patients and families identifying gaps in care, providing education, and partnering with our continuum in an effort to reduce unplanned hospitalizations and help ensure the right care at the right time In this role you may work with. . . Regional Director - Care Management Providers, Nurse Practitioners, Physician Assistants HCPC/Hospice/Home Health Staff Clinical Liaisons HCMG Patients Patient's Families Community Agencies Care Givers Qualifications Required Knowledge, Skills and Experience Active R.N. License 2 or more years of direct home health experience or care management Must maintain a valid driver's license and good driving record Ability to perform extensive telephone assessment Knowledge of Medicare regulations and home care and hospice standards Must be self-motivated, independent, structured, organized, very detailed and able to meet deadlines Works closely with all providers to include Physicians, Nurse Practitioners (NP), Physician Assistants-(PA) regarding: Criteria for home care referrals Case conferencing to coordinate care, improve documentation and communication Patient education materials Assists with documentation to support eligibility of patient under the care of hospice or home care (which may include chart audit worksheet, Labs, diagnostics, History and Physical, Fast Scale, Mortality Risk Scale, etc.*) Participates in developing and enhancing tools and company initiatives that promote patient services Maintain productivity expectations related to patient visits, telephonic outreach assessments and other duties as assigned Preferred Knowledge, Skills and Experience Bachelor of Science May be required to obtain multi-state licensing 1 year experience of discharge planning 1 year leadership and/or supervisory experience Pay Transparency Individual compensation packages are based on various factors unique to each candidate, including skill set, experience, qualifications, and other job-related considerations. Notice HarmonyCares and HarmonyCares Hospice are not affiliated with Harmony Hospice Care. HarmonyCares Hospice does not conduct business in OH. HarmonyCares Hospice conducts business in MI, VA, WI, TX, IN, IL.