Care Manager - Ambulatory Referral Coordination (Galveston)
: Job Details :

Care Manager - Ambulatory Referral Coordination (Galveston)**Galveston, Texas, United States**Nursing & Care ManagementUTMB HealthRequisition # 2403895**Minimum Qualifications:**Bachelor's degree in nursing or related field or equivalent and two years of case management experience or four years related experience.**Licenses, Registrations, or Certifications:**Licensure as a Registered Nurse (RN)**Job Description:**To assess, counsel, educate and provide problem solving to assigned patient population. To provide timely and valid information to the interdisciplinary team, physicians and community partners related to the on-going and follow-up care of program specific chronic disease patients. Acts as an advocate for patients and coordinates and collaborates with the medical home to provide quality, cost-effective care and promote positive outcomes for all Community Health Program patients.**Job Duties:**+ Screens and/or assesses patient and/or family to determine on-going care needs, identify barriers and solutions to self management and health care access.+ Documents appropriately on all care management activities in the Pecsys medical record and other departmental databases.+ Creates an individualized care plan that addresses the patient's disease specific educational needs and works with the patient to set self-management goals.+ Works effectively with assigned Community Health Worker to coordinate educational interventions and action plan items according to the established plan of care.+ Interacts with each patient at least monthly via telephone or in person contacts.+ Participates in activities that improve the quality and efficiency of patient care.+ Coordinates patient care throughout enrollment in the program, ensuring that plans are communicated among the medical home practitioners, ancillaries and community partners caring for the patient.+ Utilizes approved specialist referral criteria and provides necessary supporting documentation to the medical director as required for on-going specialty care needs. Coordinates specialist care via the UTMB Admissions & Financial Counseling departments.+ Enrolls patients in a timely manner based on department policy.+ Accountable for professional practice, including time management, clinical documentation, statistical and other record-keeping as needed. Reports as required to the appropriate Team Leader or designee.+ Facilitates productivity, team-building, and high team morale in the department.+ Attends educational seminars to keep abreast of current knowledge in the field of nursing, chronic disease and/or care management.+ Participates in the planning, development, implementation, and evaluation of special projects, programs, and research, as assigned.**Salary Range:** Actual salary commensurate with experience or range if discussed and approved by hiring authority.**Equal Employment Opportunity**UTMB Health strives to provide equal opportunity employment without regard to race, color, religion, age, national origin, sex, gender, sexual orientation, gender identity/expression, genetic information, disability, veteran status, or any other basis protected by institutional policy or by federal, state or local laws unless such distinction is required by law. As a VEVRAA Federal Contractor, UTMB Health takes affirmative action to hire and advance women, minorities, protected veterans and individuals with disabilities.Compensation