Registered Nurse (RN) Case Manager | Spirit LakeClinic

Lakes-Avera Medical Group Spirit Lake Work Shift :

Primarily days with rotating weekends and holidays (United States

of America) The pay range for this position is listed below. Be

part of a multidisciplinary team built with compassion and the goal

of Moving Health Forward for you and our patients. Accountable for

supporting patient care navigation in the clinic setting. The RN's

primary responsibility is to manage care for the patients of the

primary care practice to promote effective education,

self-management support, and timely health care delivery. This will

include developing and monitoring care management processes and

support primary clinical teams with these efforts. It will also

include identifying the high acuity patient population and working

to ensure care coordination for this patient population. The RN

will work with the clinic leadership and medical director (lead

physician) of the practice to develop this position to best serve

the needs of the patient panel and the primary care teams. This

individual will work closely with the leadership of Care

Coordination / Medical Home and others to support the development,

maintenance, and reporting of quality measures within the medical

home model. Works with all clinical teams as a resource on care

management of all patients of the practice, including educating the

patient about self-management tasks they can undertake to gain

greater control of their health status, and, manage patient care in

the health care continuum to achieve optimum outcomes in a safe and

cost-effective manner. Collaborates with physicians, providers, and

practice staff in identifying appropriate patients for care

management, and provides leadership for patient care teams. Works

with social services and nursing to identify, plan for, and provide

an appropriate follow-up plan of care for patients. Communicates

this plan of care to patient’s families, medical providers,

hospital staff when appropriate, community support, other agencies

and departments. Provides follow-up contact with patient as

indicated to ensure compliance with recommendations – medications,

lab / x-ray, specialists visits, PCP visits, dieticians, CDE, etc.

Reviews monthly status reports, dashboard results, and other

information related to clinical care delivery. Communicates with

physician groups’ regarding statistical and financial impact of

care delivery. Serves as a resource for clinic care team education

on changing payor requirements. Collaborates with payer Case

Managers for additional services when appropriate. Anticipates the

needs of this patient population, seeing that necessary

documentation and pre-visit planning is completed or requested

before patient visit. Promotes patient self-management and empowers

patients / families to achieve maximum levels of wellness and

independence. Assesses barriers when patient has not met treatment

goals, is not following treatment plan of care, or has not kept

important appointments. Oversees the development, procurement and

adoption of patient self-management educational resources used by

the primary clinical teams. To perform this job successfully, an

individual must be able to perform each essential job function

satisfactorily including having visual acuity adequate to perform

position duties and the ability to communicate effectively with

others, hear, understand and distinguish speech and other sounds.

Reasonable accommodations may be made to enable individuals with

disabilities to perform the essential job functions, as long as the

accommodations do not cause undue hardship to the employer.

Required Education, License / Certification, or Work Experience : ~

Registered Nurse (RN) - Board of Nursing An active license in the

state of practice Upon Hire Preferred Education,

License / Certification, or Work Experience : ~1-3 years of Clinic

Nursing experience ~4-6 years Case Management and / or homecare

experience Commitment to the daily application of Avera’s mission,

vision, core values, and social principles to serve patients, their

families, and our community. Uphold Avera’s standards of

Communication, Attitude, Responsiveness, and Engagement (CARE) with

enthusiasm and sincerity. Comply with safety principles, laws,

regulations, and standards associated with, but not limited to,

CMS, The Joint Commission, DHHS, and OSHA if applicable. Avera is

proud to offer a wide range of benefits to qualifying part-time and

full-time employees. We support you with opportunities to help live

balanced, healthy lives. Free health insurance options, for

full-time single coverage on Avera High Deductible Health Plan Up

to 5% employer matching contribution for retirement Career

development guided by hands-on training and mentorship Avera is an

Equal Opportunity Employer - Qualified applicants will receive

consideration for employment without regard to race, color,

religion, sex, national origin, disability, Veteran Status, or

other categories protected by law. If you are an individual with a

disability and would like to request an accommodation for help with

your online application, please call 1-605-504-4444 or send an

email to talent@avera.