Care Manager Registered Nurse GCM - University

Facilitates communications among patient/family, multidisciplinary team, medical management team, community resources and other disciplines to anticipate, identify, evaluate, and act to resolve any potential barriers and constraints to delivery of care in a timely manner. Uses evidenced-based approaches to increase patient and family activation and engagement in their own care. Independently manages CM caseload according to department expectations.

Partners with identified at-risk patients throughout the diagnosis, treatment and follow-up in order to deliver continuity of care. Coordinates patient information and communication between and among the patient/family, the referring/accepting facilities and physicians, community caregivers and other members of ACM to ensure smooth transitions of care. Uses the nursing process with at-risk patients to assess, plan, implement and evaluate clinical strategies leading to quality results, optimal cost/utilization and patient experience.