Sanford Health Senior RN Care Manager Ambulatory - Enterprise Clinic Services in Bemidji, Minnesota

Job Title: Senior RN Care Manager Ambulatory | Enterprise Clinic Services | Bemidji


State: Minnesota


Job Schedule: Full Time

Shift: Days

Hours Per Shift: 8 hr


Expert level in responsibilities including utilizing the professional nursing process to provide individualized nursing care.May perform rounds with or without physician in hospital and on hospital patients. May place verbal or telephone orders using read back. Abides by respective healthcare agencys policies.Collects and relays medical information (assessment, screening, diagnostic testing results and risk stratification) to providers on both hospital and clinic patients enrolled in the approved programs. Patient education is individualized to patient needs and condition, provider instruction. Care planning is individualized to patient needs and conditions and ensures it is updated. Assists with the coordination of patient care across the continuum by collaborating with physicians, advanced practice providers, staff and other professionals. Is a liaison with the healthcare team, and serves as a link to community resources. Works with the clinical team and manages the disease registries by identifying and following up with patients not meeting clinical and evidenced-based goals as well as Sanford approved Clinical Practice Guidelines. The Care Coordinator-Ambulatory Inpatient also works with the clinical team and may assist or conduct the pre-visit chart review to prepare for a comprehensive patient visit by identifying health care needs based on the approved guidelines. A sampling of the duties performed by the Care Coordinator-Ambulatory Inpatient include, but are not limited to, patient assessment, data collection for research, patient education, goal setting and care planning, preparation for recommended testing; and following through with results. Patient population is inclusive of adults and geriatrics. Must be self-motivated, self-directed, and autonomous; willing to teach the healthcare team; and seeks professional development in area of expertise. Able to facilitate patient advocacy groups. Knowledgeable about reimbursement for services provided. Provides specialized, multidisciplinary patient and family centered education and coordinates off-site education opportunities as needed. Acts as an advocate for patient and families to coordinate care with insurance companies, state and institutional assistance programs and travel arrangements as needed. The Care Coordinator-Ambulatory Inpatient supports quality improvement and transformation of the health care delivery system. May delegate to licensed and unlicensed personnel within their defined scope of practice as well as students and new orients.When students and new orients are providing patient care, treatment, and/or services as a part of their training, any/all employees may be asked to supervise the students and orients.


The Sr. RN Ambulatory

Care Manager is an experienced RN who understands Population Health and patients who would benefit from a patient centered care management program that would assure medically appropriate, high quality, cost efficient care across the continuum. The Care Manager coordinates the care and services of selected patient populations across the continuum of illness; promotes effective utilization; monitors health care resources; and assumes a leadership role with interdisciplinary team throughout the region to achieve optimal outcomes through tools of care management such as clinical protocols and the analysis of variances. The Care Manager will work with multiple interdisciplinary teams to create longitudinal personalized plans for identified patients. Responsible for collaborating with and coordinating care across the continuum to include Sanford Health Plan, inpatient, outpatient, post-acute care and the patient's community resources. Also requires effective communication with patients, the community and the care team members throughout the continuum.


CCTM is required within 18 months of hire date.Must be licensed with the applicable State Nursing Board and/or possess multistate licensure privileges. Functions within the legal scopeof practice. BSN required.

About SanfordHealth:

At Sanford Health, we are dedicated to

the work of health and healing. Every day, we show that commitment by delivering the highest quality

of care to the communities we serve. We are leaders in health care and strive to provide patients across

the region with convenient access to expert medical care, leading-edge technologies and world-class


In addition to strong clinical care, we are

also committed to research, education and community growth. We engage in medical research to not

only discover innovative ways to provide care, but also cures for common diseases. We continuously

seek new ways to achieve our vision of improving the human condition here in your community, across

the region and around the world.

The entire team at

Sanford Health recognizes the value of healthy families and communities. We continue to gain

momentum and expand our reach. Together, we can make a positive difference now, and in the


Sanford is an EEO/AA Employer

M/F/Disability/Vet. If you are an individual with a disability and would like to request an accommodation

for help with your online application, please call 1-877-243-1372 or send an email

In compliance with federal law requiring employers to verify new

employees' U.S. employment eligibility, Sanford participates in E-Verify. To learn more click here forEnglish Versionor here forSpanish Version.

City: Bemidji

State: Minnesota

Job Function: Nursing

Job Schedule: Full Time

Shift: Days

Req Number: req8362