Complex Care Manager RN - Population Health

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Be part of an exceptional health care experience. Join the inspired, passionate team at Lehigh Valley Health Network, a nationally recognized, forward-thinking organization offering plenty of opportunity to do great work.

LVHN has been ranked among the "Best Hospitals" by U.S. News & World Report for 23 consecutive years. We're a Magnet(tm) Hospital, having been honored five times with the American Nurses Credentialing Center's prestigious distinction for nursing excellence and quality patient outcomes in our Lehigh Valley region. Finally, Lehigh Valley Hospital - Cedar Crest, Lehigh Valley Hospital - Muhlenberg, Lehigh Valley Hospital- Hazleton, and Lehigh Valley Hospital - Pocono each received an 'A' grade on the Hospital Safety Grade from The Leapfrog Group in 2020, the highest grade in patient safety. These recognitions highlight LVHN's commitment to teamwork, compassion, and technology with an unrelenting focus on delivering the best health care possible every day.

Whether you're considering your next career move or your first, you should consider Lehigh Valley Health Network.

Develops and implements care plans for patients with increased system utilization in collaboration with multidisciplinary care team members and providers across the continuum. Facilitates tactics to reduce unnecessary utilization through coordination between providers involved in the patients care. Coordinates activities across the continuum to ensure appropriate follow-up care, order placement, and resource support.

Job Duties

• Develops a comprehensive patient care timeline following an intensive chart review and investigation to provide a visual representation of the patient's clinical conditions, contributing factors, and associated support services.
• Oversees a population of patients with frequent healthcare system utilization through development and implementation of individualized patient care plans in collaboration with the multidisciplinary team.
• Identifies patient clinical conditions, testing needs, and evidence-based clinical interventions to assist in reducing unnecessary utilization.
• Collaborates with inpatient and outpatient team members to ensure appropriate follow-up of care that meets patient's needs.
• Identifies issues or barriers related to the healthcare system, transportation, financial concerns, or behavioral health needs and works collaboratively to problem solve, coordinate services, and arrange resources.

• Bachelor's Degree Nursing
• 10 years Experience working as a registered nurse (RN) and
• 5 years Previous experience in case management or care management and
• 5 years Prior electronic medical record (EMR) experience
• Ability to lead collaboration with multidisciplinary care team members.
• Ability to set priorities to coordinate care plan efficiently.
• Utilize effective strategies for interacting with persons from diverse backgrounds.
• Ability to recognize the role of cultural, social, economic, and behavioral factors in accessibility, availability, acceptability, and delivery of population health services.
• Knowledge of computer applications and analytical tools.
• RN - Licensed Registered Nurse_PA - State of Pennsylvania Upon Hire and
• CACRN - Certified Ambulatory Care Registered Nurse - American Nurses Credentialing Center Within 3 Years or
• CCCTM - Certified Care Coordination and Transition Management - American Nurses Credentialing Center Within 3 Years

• Master's Degree Nursing

Lift and carry 25 lbs. frequent sitting/standing, frequent keyboard use, *patient care providers may be required to perform activities specific to their role including kneeling, bending, squatting and performing CPR.

Job Description Disclaimer: This position description provides the major duties/responsibilities, requirements and working conditions for the position. It is intended to be an accurate reflection of the current position, however management reserves the right to revise or change as necessary to meet organizational needs. Other responsibilities may be assigned when circumstances require.

Lehigh Valley Health Network is an equal opportunity employer. In accordance with, and where applicable, in addition to federal, state and local employment regulations, Lehigh Valley Health Network will provide employment opportunities to all persons without regard to race, color, religion, sex, age, national origin, sexual orientation, gender identity, disability or other such protected classes as may be defined by law. All personnel actions and programs will adhere to this policy. Personnel actions and programs include, but are not limited to recruitment, selection, hiring, transfers, promotions, terminations, compensation, benefits, educational programs and/or social activities.

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