RN (Registered Nurse) Advocate

RN Advocate

CINQ Connect NY LLC

Overview

The RN Advocate reports to the Director of Clinical Operations or designee, CINQCARE, responsible for member engagement of the high-risk population with an emphasis on event-driven care management leveraging care pathways and evidenced based guidelines tailored to black and brown populations. Care Management includes assessing healthcare needs, identifying problems and opportunities for improvement, implementing patient Action Plans, managing the patient care transition process, assisting patients throughout care episodes, coordinating, and facilitating care for patients with complex, chronic medical and mental health conditions, providing disease education, and promoting evidence-based healthcare services. The individual in this position works as part of an interdisciplinary team to ensure high quality outcomes for patients/families struggling with chronic disease management. It is critical that care management be done in conjunction and always with the Caregiver, including their and the member’s signoff. Conducting Caregiver assessments are also part of the Care Management process.

Primary Responsibilities

The RN Advocate will have the following responsibilities:

• Develops Alert-driven care pathway templates by condition with risk levels and member actions by event type.
• Uses Care Pathway templates by Chronic Condition with Alerts to develop Member Action Plans
• Deploys Remote Patient Monitoring and Patient Self Reporting for High-Risk Chronic Conditions
• Conducts in-home or tele-health assessments, when necessary
• Responds real-time to patient alerts and is in active communication with the member and caregiver via text and phone. Monitors remote patient monitoring tools and notify interdisciplinary team when follow-up is required to address out of range results and or clinical outcomes.
• Provide care coordination for patients including patient navigation, chronic disease management/education and interdisciplinary collaboration while complying with department policies and procedures and other contractual requirements.
• Work with patient and care team to conduct assessments that result in a Member Action Plan prioritized by the patient and care givers. Track Member Action Plan outcomes, interventions, and continue to reassess the patient's needs as appropriate. Establish appropriate timeframe for frequency of follow-up activities and provide closure and referral services as patients move through the care continuum.
• Engage patients in taking a proactive role for managing their health, medications, treatment and mental health needs, and follow-up appointments and refer patients to the appropriate community-based organizations or other programs.
• Follow evidence-based guidelines and contact standards to facilitate closure of gaps in care and encourage and use of in network services and determine when in-home services are needed and ordered.
• Use the electronic medical record or Care Management platform to conduct care coordination activities and comply with associated policies and procedures including those for workflow and consistent documentation.
• Participate in team-based rounds to support and contribute to ongoing program design and development as lessons are learned from the field and process improvement work performed within in the department.
• Reassesses Member Action Plan Post Discharge
• Demonstrates an ability to identify and shift priorities within work assignment to effectively manage patient care load.
• Collaborates daily with interdisciplinary team for assigned patients to discuss patient care planning and care facilitation
  
  

• Collaboration: The RN Advocate will ensure that clinical capabilities form a cohesive offering, including by working closely with other business divisions to learn their needs, internalize their knowledge, and define solutions to achieve the business objectives of CINQCARE.
• Knowledge: The RN Advocate will provide subject matter expertise in the area of clinical solutions, including assessment and event-based care management
• Culture: The RN Advocate is accountable for creating a productive, collaborative, safe and inclusive work environment for the team and as part of the larger Company.
  
  

• Education. Active New York state Registered Nursing license. BSN required
• Experience. At least 5 years of relevant clinical experience experience. Ideal candidates will have 3+ years of relevant care management experience in the health plan, home health and or hospice.
• Entrepreneurial. CINQCARE seeks to fix gaps that have persisted for generations in the delivery of care to Black and Brown populations. This position is accountable for ensuring CINQ is positioned to innovatively deliver on its promise.
• Communication. Excellent verbal, written communication, and presentation skills; ability to clearly articulate and present concepts and models in an accessible manner to CINQCARE’s team, investors, partners, and other stakeholders. Proficiency in all Microsoft Office applications.
• Relationships. Ability to build and effectively manage relationships with business leaders and external constituents.
• Culture. Good judgement, impeccable ethics, and a strong team player; desire to succeed and grow in a fast-paced, demanding, and entrepreneurial Company.