Position/Job Title:
Reports to:
Approved/Revised Date:
Job Code:
Pay Class:
Condition Management Nurse
Program Manager Condition Management
01/20/2014
E-005/E-006
E-005/E-006
Summary:
The Condition Management (CM) Nurse is responsible for the implementation of the Integrated
Health Partners (IHP) condition management program. This program focuses on improving the
health status of individuals with specific chronic conditions ultimately resulting in improved
quality of life for the participant, a more engaged employee for the customer/employer, and
health care cost savings for the customer/employer. The CM Nurse identifies potential enrollees
within targeted populations with specific conditions, conducts outreach, facilitates engagement in
the customer CM program, assesses participant needs, and together with participants develops
plans to address needs/issues related to condition(s) and/or overall health.
Essential Functions:
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Using risk stratification system, targets enrollees in customer’s condition management
program for outreach.
Conducts outreach by telephone, secure e-mail, or mail with goal of engaging enrollee in
program.
Conducts condition management education regarding the condition, symptom
management, red flag warning signs related to the condition, importance of adhering to
medications and evidence-based guidelines, and refers to customer sponsored support
programs as appropriate for individuals with target chronic conditions or within identified
sub-populations.
With participant, establishes self-management goal using self-management support
concepts and motivational interviewing techniques.
Develops and implements plans to increase client motivation and self-efficacy in all
aspects of chronic condition management.
Documents all condition management activities appropriately, promoting accurate and
timely reporting to customer.
Additional Responsibilities/Duties:
(The following examples are intended to be descriptive but not restrictive.)
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Applies the principles of the nursing process to condition management of individuals
with chronic conditions.
Revises the risk score of a participant based on information obtained during
conversations with the participant.
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Monitors clinical objectives related to clients’ chronic conditions, including self-reported
ability to do regular daily activities and be productive at work, avoid hospital and
emergency department admissions, and reduce gaps in evidence-based care.
Encourages participant to consent to sharing of information between CM nurse and
primary care physician.
Assists with program development, planning, and meetings with customer as requested.
Maintains a working knowledge of applicable Federal, State and local laws and
regulations, the Compliance Accountability Program, Code of Ethics, ERISA, HIPAA
privacy and transaction and code set requirements, as well as other policies and
procedures, in order to ensure adherence in a manner that reflects honest, ethical and
professional behavior.
Demonstrates commitment to providing outstanding customer service in a manner that is
reflective of our mission, values, and customer service standards.
Performs related duties as assigned.
Education/Experience (Minimum Requirements):
RN with current Michigan license in good standing; Bachelor’s degree in nursing or health
related field preferred. Minimum three years clinical experience. Certified Case Management or
Chronic Care Nurse preferred. Stanford Self-management (PATH) certified or commitment to
complete the training is desired.
Specific Knowledge, Skills, Licenses, Certifications, Etc:
Experience:
Three to five years clinical nursing experience in acute care setting or equivalent ambulatory
experience. Additional experience in home health, physician practice, or other community
setting preferred.
Skills:
Ability to communicate orally and in writing clearly and assertively.
Ability to analyze, plan, and problem-solve effectively.
Ability to organize, prioritize, and be flexible.
Licensure: RN with current Michigan license in good standing.
This position will require flexible daytime and evening hours to accommodate participant
needs. Weekend on call hours will be required.
Integrated Health Partners (IHP) is committed to the principle of equal opportunity in
employment. Integrated Health Partners does not discriminate on the basis of gender, race,
color, creed, national origin, age, religion, sexual orientation, veteran status, or disability in
participation in, access to, or employment in its organization, programs and activities.
The above statements are intended to describe the general nature and levels of the work performed
and are not exhaustive lists of all duties, responsibilities, knowledge, skills, and abilities and
working conditions associated with the job. As changes occur IHP reserves the right to modify the
above description.
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