Clinical Care Manager (RN)
Chronic Care Management

Care Vitality

CareVitality, Inc. is seeking experienced RNs. We are a Technology Consulting and Care Management company that assists Physicians/Practitioners who treat Medicare patients with two or more chronic conditions. Each chronic care patient must receive a minimum of 20 minutes spent on their case each month. This time includes wellness checks by phone, education on their conditions, care coordination, assistance with appointments, prescription refills and referrals, etc…. Each RN will manage a case load of 250-300 patients. This job is telephonic and employees work at their designated office location (must be licensed in their state of practice). Candidates must have excellent phone skills, be comfortable calling patients to discuss care, make appointments and provide education without direct supervision. You must have superior time management and communication skills, show initiative and be self- motivated. Multi-tasking is required as you will need to be able to navigate the platform of their EHR, the internet, email, text as well as document their time spent with each patient and manage and monitor that each patient in under your management receives the required time and elements to meet the Chronic Care Management Program. A positive attitude and willingness to receive instruction and guidance from supervisor is a must. Meeting the quota of at least 20 minutes on 250-350 patients per month is a criteria for continued employment. Past experience in care management, care planning, discharge planning or home health preferred, must have experience using an EHR/EMR.

Key Responsibilities

  • Conduct comprehensive assessments that include the medical, behavioral, pharmacy, and social needs of the patient and identify gaps in care based on clinical standards of care.
  • Provide CCM patients with appropriate education materials or resources to enhance their knowledge and skills related to health or lifestyle management.
  • Contact patients with gaps in preventive health care services and assist them to schedule required screening or diagnostic tests with their providers.
  • Review patient’s current medication profile; identify issues related to medication adherence, and address with the member and providers as necessary. Refers patients for Comprehensive Medication Review as appropriate.
  • Successfully engage patient to develop an individualized plan of care in collaboration with their primary care provider that promotes healthy lifestyles, closes gaps in care, and reduces unnecessary ER utilization and hospital readmissions. Coordinates and modifies the care plan with patient, caregivers, PCP, specialists, community resources, behavioral health contractor, and other health plan and system departments as appropriate.
  • Document all activities in the EHR and time elements in the care management tracking system following EHRPMC standards and identify trends and opportunities for improvement based on information obtained from interaction with patients, providers and technology solutions utilized.

Basic Qualifications

  • Minimum of 2 years of experience in a clinical and/or case management, discharge planning or home health nursing preferred. Experience working with an EHR/EMR required.
  • Ability to create custom comprehensive Care Plans for Patients
  • Ability to incorporate both behavioral health and physical health management in an EHR/EMR system preferred.
  • Must be able to pass a drug test and extensive background check.
  • Ability to interact with patients, physicians and other health care professionals in a professional manner required.
  • Excellent verbal and written communication and interpersonal skills required. Computer proficiency required.
  • Please list any languages you are fluent in other than english in your resume and in the header of your email as well along with the job you are applying.  Spanish and Farsi are languages some of our clients need at the moment.

Licensure/Certifications

RN in the State where they will be working.

If interested in applying, please email your resume to contact@carevitality.com or call 1-800-367-0212

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