Saturday, October 5, 2019

The Registered Nurse Care Manager Role

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The Registered Nurse Care Manager Role. Registered Nurse care managers are at the core of supporting patients with complex health needs or high-risk clinical events.

While registered nurse care managers provide traditional clinical triage and assist medical providers and the rest of the care team with patient tasks during office visits, West County has prioritized the unique skills and background of registered nurse care managers to focus on care provided between office visits.

This includes care coordination with other health systems, chronic disease care management for patients who are not meeting specific health targets, hospital and ER transitional care, high-risk disease and lab tracking, and care management for higher cost/higher utilization patients.

registered nurse care manager roles

Responsibilities of Registered Nurse Care Managers

Registered Nurse care managers also coordinate services with other members of the care team, behavioral health staff, and community health workers for specific patient needs and provide an invaluable role in communication and coordination with patients.

West County Health Centers' staffing model is fully funded within the operating budget of the agency and does not rely on increased productivity or increased charge capture to remain solvent.

Financial viability is achieved by a strong commitment from agency leadership to the current care delivery model, with very lean operational costs and overhead.

Medicaid services in West County

West County has realized increasing financial reimbursement from its managed Medicaid health plan, fee-for-service reimbursement for hospital transition care, and an "Intensive Outpatient Care Management" grant for reducing costs and utilization for high-risk patients.

Further, West County Health Centers, Inc., receives reimbursement for chronic care management from the Centers for Medicare & Medicaid Services and has partnered with four other community health centers to start an accountable care organization.

West County Health Centers has been on its current journey of care delivery transformation for the past 10 years. It recognized early that primary care redesign is complex, takes a significant amount of time, and requires a commitment to comprehensive team transformation.

The Complex Role of a Registered Nurse Manager

The role of the Registered Nurse care manager has been the most complex in the redesign process, requiring high-functioning medical assistants as well as behavioral health and front office staff members to support work that would commonly compete for the time and priority of the Registered Nurse.

It also requires a strong commitment by agency leadership to focus on care that is not reimbursed in the traditional primary care environment.

West County has committed to developing and staffing the role of the Registered Nurse care manager, understanding that Registered Nurses will continue to play a critical role in a transformed primary care environment.
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