The Nurse Care Manager works collaboratively with physicians and
other members of the health care team to improve the health of
patients with chronic conditions or complex needs. This position
educates patients and families to help them manage their health
care needs. The incumbent facilitates communication, coordinates
services, addresses barriers, and promotes optimal allocation of
resources while balancing clinical quality and cost management.
Nurse Care Manager-MG works in the ambulatory setting. The
position may work in a general care manager model to support three
or more clinics within a scope narrowly aligned with designated
Primary Care Clinical Program initiatives or may work in a
Personalized Primary Care model (1-2 clinics) with broad scope for
a defined patient population. Patient interactions may be in
person, by telephone, or other electronic means.
General case management
Responds to physician referrals and identifies patients who meet
established criteria for care management (e.g. HgA1c > 8,
elevated LDL and/or B/P, Mental Health Integration referral,
complex resource needs).
Assesses family, social, cultural characteristics.
Understands communication needs (e.g., vision, hearing).
Assesses behavioral and family risk factors.
Screens for chronic disease (e.g. depression).
Reviews patient understanding of medication treatment.
Chronic Disease Management
Utilizes a working knowledge of established care process models
and other applicable standards of care.
Provides focused patient education using established content and
Uses clinician approved and appropriately documented standing
Establishes individualized care plan including treatment goals
in collaboration with patient and consistent with medical plan of
Reviews care plan and assesses progress toward treatment goals
and barrier at each relevant visit.
Coordination of Care
Coordinates with care managers in other settings as
Provides information on enabling services (e.g.,
Maintains list of key community services agencies with contact
Provides information about recommended or available services and
Personalized Primary Care.
Support Patient in Self-Management and Behavior Change Using
Motivational Interviewing and Coaching
Assesses readiness to change.
Assesses and tracks patient capacity for and confidence in
Develops self-care plan in collaboration with patient.
Provides self-monitoring tools.
Provides or connects patients with support programs.
Assesses and supports patients in adopting healthy
Assesses and arranges treatment for mental health and substance
Manage Populations, Disease Registries and Preventive Care
Establishes process to monitor patient adherence to medical plan
Focuses on prevention measures consistent with established
guidelines and care process models
Reviews and manages quality reports related to chronic disease
Supports clinicians in achieving quality incentives.
Team Based Care
Works collaboratively with referring physician and other members
of care team
Personalized Primary Care:
Completes pre-visit planning (review chart before visit, notify
patient of tests needed before the visit)
Facilitates advanced care planning (Advanced Directives).
Establishes a process for reminder letters and phone calls.
Supports clinicians and team to achieve personalized primary
Facilitates transitions of care (e.g., unscheduled hospital
admissions, emergency department visits, skilled nursing home).
Tracks status of critical referrals.
Follows up to obtain report back from referral clinician.
In collaboration with clinician, establishes written care plan
for patients transitioning from pediatrics to adult.
Provides information on health insurance resources.
Supervises and supports Health Advocates.
Attends clinic team meetings and medical home meetings to assist
with process design and help resolve team issues.
Supports development of agenda for team meetings.
Reviews data summary on regular basis.
+ Benefits Eligible: Yes; Medical, Dental, Vision, Education
Assistance. Click here
for more details
+ Shift Details: Full time - Exempt
+ Department/Unit: Castell Care Management - River Road Clinic-
+ Additional Details: Remote/ Work from home.
Bachelor's degree in Nursing (BSN). Education must be obtained
from an accredited institution. Degree will be verified.
Current RN license for state in which the nurse practices.
- and -
BLS certification for healthcare providers.
Three years of clinical nursing experience.
- and -
Basic computer skills and knowledge of word processing
Experience in case management, utilization review, or discharge
Ongoing need for employee to see and read information, labels,
monitors, identify equipment and supplies, and be able to assess
- and -
Frequent interactions with patient care providers, patients, and
visitors that require employee to verbally communicate as well as
hear and understand spoken information, alarms, needs, and issues
quickly and accurately, particularly during emergency
- and -
Manual dexterity of hands and fingers to manipulate complex and
delicate equipment with precision and accuracy. This includes
frequent computer use and typing for documenting patient care,
accessing needed information, etc.
Cedar City Hospital, River Road Clinic
**Scheduled Weekly Hours:**
Being a part of Intermountain Healthcare means joining a
world-class team of over 38,000 employees and caregivers while
embarking on a career filled with opportunities, strength,
innovation, and fulfillment. Our mission is: Helping people live
the healthiest lives possible.
Our patients deserve the best in healthcare, and we deliver.
To find out more about us, head to our career site here
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**Equal Opportunity Employer**
Intermountain Healthcare is an equal opportunity employer.
Qualified applicants will receive consideration for employment
without regard to race, color, religion, sex, sexual orientation,
gender identity, national origin, disability or protected veteran
The primary intent of this job description is to set a fair and
equitable rate of pay for this classification. Only those key
duties necessary for proper job evaluation and/or labor market
analysis have been included. Other duties may be assigned by the
All positions subject to close without notice. All qualified
applicants will receive consideration for employment without regard
to race, color, religion, sex, sexual orientation, gender identity,
age, national origin, disability or protected veteran status.
Women, minorities, individuals with disabilities, and veterans are
encouraged to apply.
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