GENERAL STATEMENT OF DUTIES:

Provides professional nursing care for Utah Cancer Specialists patients following established national standards and practices. A Nurse Care Manager is a professional registered nurse who offers individualized assistance to patients, families, and caregivers. The Nurse Care Manager is responsible for coordinating and overseeing the care of patients, ensuring they receive high-quality, comprehensive health care services, including care delivered through Principal Care Management (PCM) and Transitional Care Management (TCM) programs. Utilizing the nursing process, the Nurse Care Manager provides education and resources to facilitate informed decision-making and timely access to quality health and psychosocial care throughout all phases of the cancer continuum.

DUTIES AND RESPONSIBILITIES:

• Conduct initial assessments of patients' health status and develop individualized care plans in collaboration with the healthcare team.
• Coordinate with physicians, specialists, and other healthcare professionals to ensure continuity of care for patients.
• Monitor patients' progress and make adjustments to care plans as needed.
• Provide outreach and education to patients and their families about their medical conditions, treatment options, symptom management, and self-care techniques.
• Advocate for patients and ensure their needs are met within the healthcare system.
• Assess patients' eligibility for community resources and assist with referrals as necessary.
• Document patient interactions, care plans, and interventions accurately and timely in electronic medical records and in care management platform.
• Participate in interdisciplinary team meetings to discuss patient progress and collaborate on treatment plans.

CARE MANAGEMENT PROGRAM RESPONSIBILITIES:

• • Principal Care Management (PCM): Identify and support eligible patients with a serious chronic condition requiring ongoing clinical management. Complete and update individualized care plans; provide scheduled outreach, education, symptom and medication review, care coordination, and follow-up; communicate changes or concerns to the provider; and document care management activities and time in the designated systems in accordance with program requirements.
• • Transitional Care Management (TCM): Review hospital and discharge information to identify eligible patients transitioning from an inpatient or other qualifying setting. Perform timely post-discharge outreach, review medications and discharge instructions, assess symptoms and barriers to recovery, coordinate needed services and follow-up appointments, escalate clinical concerns, and document all TCM activities in accordance with program requirements.
• • Maintain accurate documentation of enrollment, patient consent when required, care plans, outreach, interventions, care coordination, and time associated with PCM and TCM services to support continuity of care, quality reporting, and compliant billing.

QUALIFICATIONS AND EXPERIENCE:

Knowledge, Skills & Abilities:

Knowledge of professional nursing theory and practice to evaluate patient care needs, safety, and required resources for the oncologic patient. Skilled in developing and maintaining department relationships, quality assurance metrics and policy/procedure delivery. Effective in establishing and maintaining successful working relationships with patients, medical staff and community providers. Ability to communicate clearly.  

EDUCATION/TRAINING REQUIREMENTS: Graduate of an accredited school of nursing. Experience in care management and oncology preferred

CERTIFICATE/LICENSE REQUIREMENTS: Possession of a current State Registered Nurse License. BLS certification.