NURSE MANAGER

The Lakelands Cares Case Manager reports to the Program Director. The Nurse Manager qualifies coordinates care and services for the low income, uninsured population of the Lakelands region and is responsible for assessment and management of Lakeland Cares individuals with emphasis on psychosocial wellness, medication assessment and reconciliation, planning care, and health coaching through the use of motivational interviewing techniques and patient self-management techniques. Lakelands Cares Nurse Manager will also assist with events and meetings, and the management of the front office and waiting area, attending to patient’s needs as necessary.

Assessment
 Conducts psycho-social assessment
 Obtains medical/surgical history
 Conducts medication assessment & reconciliation
 Assessment of patient’s self-management components to include health beliefs, readiness to change, confidence (self-efficacy) and importance
 Evaluate effectiveness of care management services

Planning Care
 Develops plan of care
 Monitors patients progress towards goals
 Conducts follow up and reassessments with patient at regular intervals
 Interdisciplinary case conferences

Health Coaching
 Uses motivational interviewing techniques
 Utilizes patient self-management techniques
 Provides education and training for individuals and staff

Coordination of care and services
 Demonstrates current knowledge of community resources appropriate to setting and population.
 Assists patient with navigation of the healthcare system and community services
 Maintains effective communication with hospitals, physicians, community agencies, etc.
 Oversees the patient throughout the continuum of care
Documentation
 Documents all interactions with patients including assessment and plan of care updates.
 Participates in the development and implementation of QI plans

Additional assigned duties as required.

No Reloc

About Lakelands Cares: Funded by the Duke Endowment, the purpose of Lakelands Cares is to provide a coordinated community approach to caring for the uninsured. The major program goals and priorities are the following: connecting clients to a medial home; expanding capacity of current providers by engaging the medical community; utilizing a case management model to coordinate care, helping clients navigate programs, and addressing the barriers they face; and coordinating eligibility efforts to work in partnership to qualify people for multiple services through one portal.