We have an exciting opportunity for an experienced nurse to join our Ambulatory Division as a Care Manager, working with high risk patients in our General Internal Medicine Clinic and our Women's Health Care Center. Unique Job Functions to Care Management:1. Population Managementa) Identifies patient populations requiring care management support.b) Assesses patient populations to identify those resources or other factors needed to achieve the desired outcome for health maintenance or health improvement.c) Coordinates healthcare interventions for populations with significant health conditions in which self-management efforts are critical.d) Maintains appropriate patient educational materials for populations of patients to meet the needs of patients and families in order to assist with the facilitation of their participation in the plan of care.e) Analyzes data related to patient populations/conditions and develops a plan of action. Monitors progress over time and initiates changes as needed.f) Develops strategies to meet the preventive care and health maintenance measures for populations of patients.g) Develops professional relationships with community resources that are used by UWMC to care for populations of patients. (e.g. Home health, hospice)h) Monitors monthly quality measures, looks for trends and makes plans for improvements. Identifies problem areas for monitoring and evaluation and is active in analyzing findings, changing practice based on the findings.i) Works collaboratively with the clinic team to promote activities that support the overall goals of the clinic related to caring for different populations of patients2. Care Managementa) Assists in the management of patients with high-risk or multiple chronic diseases following established protocols and systems for disease management in collaboration with providers.b) Outreaches to and builds relationships with patients in need of care management support.b) Assesses patient learning needs and has the ability to develop and implement individualized educational or care plans. Reviews, evaluates and revises the plan on an ongoing and timely basis.c) Communicates with a multidisciplinary team (physicians, nurses, therapists, social workers, etc.) as needed.d) Develops self-management goals and monitors the progress of the goals.e) Has the ability to oversee and assist the patient with referral navigation.f) Initiates disease-specific care conferencing as needed.g) Utilizes patient communication strategies, e.g. motivational interviewing, to involve the patient in developing a plan of care, goals or other specific measures pertinent to their health condition.h) Assesses patient activation and readiness for change and uses these to develop self-management goals.i) Participates in confidence level assessments or surveys of patients to improve disease management care delivery processes.j) Documents all disease management encounters using standardized processes.k) Acts as a liaison between the patient and the clinic, other hospital departments and community resources.l) Utilizes the Epic Care Team functionality to become part of the care team for identified patient populations.Care Management Education, Training and Competency1. Stays abreast of current and updated clinical practices, policies and procedures. Is able to provide clinical expertise in the development of such documents.2. Participates in the training of new staff for population management, disease management and utilization management.3. Maintains job-specific certification.a. Completion of the American Association of Ambulatory Care Nurses (AAACN) Care Coordination and Transition Management (CCTM) Course within three months of hire. b. CCTM certification is to be completed within one year of hire. Position is 70%-100%, 8 hour days, and requires WA RN license, two years of current/recent nursing experience in an outpatient setting, CCTM certification or completion within one year of hire. BSN preferred.As a teaching hospital and research center, we're deeply committed to the enhancement of care for our patients-as well as the professional growth of our staff. As a testament to this commitment, we're proud to be recognized with Magnet Hospital status by the American Nurses Credentialing Center. In fact, we were the first hospital to receive this designation. We're also consistently named one of the nation's best hospitals, as reported by U.S. News and World Report. Such national recognition attests to our commitment to high-quality care, and to the outstanding professionalism and skill that exists at UWMC. As a registered nurse (RN), you can be a part of this highly skilled team, working within a culture that is both innovative and collaborative. Here, you will work in tandem with physicians and other health care practitioners to provide superior, award-winning nursing care. In short, you will not only follow best practice, you will create it!
Founded in 1861, the University of Washington is one of the oldest public institutions in the west coast and one of the preeminent research universities in the world. The University of Washington is a multi-campus university comprised of three different campuses: Seattle, Tacoma, and Bothell. The Seattle campus is made up of sixteen schools and colleges that serve students ranging from an undergraduate level to a doctoral level. The university is home to world-class libraries, arts, music, drama, and sports, as well as the highest quality medical care in Washington State and a world-class academic medical center. The teaching and research of the University’s many professional schools provide undergraduate and graduate students the education necessary toward achieving an excellence that will serve the state, the region, and the nation. As part of a large and diverse community, the University of Washington serves more students than any other institution in the Northwest.