Care Transitions Nurse - Atrium Remote FT Evenings 12:00p-8:30p

Advocate Health is the third-largest nonprofit, integrated health system in the United States, created from the combination of Advocate Aurora Health and Atrium Health. Providing care under the names Advocate Health Care in Illinois; Atrium Health in the Carolinas, Georgia and Alabama; and Aurora Health Care in Wisconsin, Advocate Health is a national leader in clinical innovation, health outcomes, consumer experience and value-based care. Headquartered in Charlotte, North Carolina, Advocate Health services nearly 6 million patients and is engaged in hundreds of clinical trials and research studies, with Wake Forest University School of Medicine serving as the academic core of the enterprise. It is nationally recognized for its expertise in cardiology, neurosciences, oncology, pediatrics and rehabilitation, as well as organ transplants, burn treatments and specialized musculoskeletal programs. Advocate Health employs 155,000 teammates across 69 hospitals and over 1,000 care locations, and offers one of the nation’s largest graduate medical education programs with over 2,000 residents and fellows across more than 200 programs. Committed to providing equitable care for all, Advocate Health provides more than $6 billion in annual community benefits.

Department: 39733 Enterprise Corporate - Care Transitions Status: Full time Benefits Eligible: Yes Hours Per Week: 40 Schedule Details/Additional Information Preferred qualifications: 3+ years RN: experience in case management, triage, with prior telephonic/remote experience. Monday-Friday, 1200-2030. This is a remote work from home position. Must have high speed internet. Must live within 1 hour of Mint Hill Primary Care office. Potential to include holidays. Pay Range $37.50 - $56.25 Must live within an hour of Mint Hill 3+ years of inpatient experience in the Med Surg area with additional experience in the ED/Clinic setting is a plus. Having experience talking with patients on the phone is also a plus, since all their work will be done via phone Job Summary: Facilitates a lifelong, proactive partnership with patients to enhance and personalize management of health-related needs. The Care Manager assesses needs, plans, coordinates, and evaluates services of patients with the goal of equipping and empowering individuals and their families to easily access resources and adopt healthy lifestyles that will increase their ability to remain in the most appropriate care setting. Care Managers focus on five primary areas: 1) population management, 2) patient self-management support, 3) transitions in care, 4) resource connection, and 5) appropriate resource utilization. Works collaboratively and maintains active communication with the multidisciplinary care team including providers, pharmacists, social workers, behavioral health specialists, and nurses to achieve timely, appropriate patient management.

Utilizes RN process as a framework to focus the activities of the healthcare team on the achievement of optimal outcomes, resource utilization, clinical expertise, and improvement strategies. Interacts with patients, professionals, and the community to achieve continuity of care, coordination of services and to document plans of care across multiple care settings. Conducts or participates in comprehensive “all-system” needs assessment for identified patients; knowledgeable of appropriate care-related services to match identified needs disease management for health maintenance, and appropriate clinical goal expectations/outcomes for identified population. Develops and maintains accurate case records of each referred customer/patient. Documents fully and accurately; knowledgeable of and utilizes accurate computer databases and documentation systems. Maintains knowledge of various reimbursement criteria and documentation necessary for reimbursement, including Medicaid, Medicare, and Managed Care. Demonstrates leadership in the professional practice of nursing evaluating his or her own nursing practice in relation to professional practice standards and guidelines, relevant statues, rules and regulations.