Employment Opportunities

Disease Management Nurse

Sinai has an exciting opportunity for two Full Time Diease Management Nurses. Disease management encompasses the clinical, economical and psychosocial aspects of providing health care and entails a certain amount of proactive, preventative services. Disease management seeks to influence or encourage the modification of the health-related behaviors of patients, providers and purchasers to reduce the occurrence and severity of certain disease states or conditions. The Disease Management Nurse:

 

  • Provides a comprehensive assessment of patient risk and needs for education, discharge planning and resource needs during an episode of illness and across the continuum of care
  • Directs the patient throughout the system by coordinating care with the PCP, physician, direct care staff, interdisciplinary team which includes the patient and family; arranges for a PCP for patients who do not have an existing relationship
  • Streamlines transitions in and out of the hospital, speeds up referrals and ensures prompt scheduling of follow-up appointments taking in to consideration patient preference and schedule;  reinforces discharge plan and compliance
  • Working with the interdisciplinary team, develops and implements disease specific protocols and order sets for the entire continuum of care based upon the latest evidence based recommendations; Collects data on the utilization and effectiveness of these tools and recommends changes as necessary and as the evidence changes.
  • Develops effective working relationships with PCPs, Specialists, care team members, home health agencies, SHS administrative leadership, medical leaders, SCI and SUHI program staff, clinic networks, and other support organizations
  • Assures that an appropriate plan of care is created and documented for the patient; ensure that the plan of care is appropriately communicated and understood by the health care delivery team.
  • Assess and document patient’s readiness to change and self-management abilities; provides teaching to the patient that provides them with information that is comprehensive and culturally appropriate; employs advanced teach-back methods.
  • Coordinates the creation of the  After Hospital Discharge Plan; reviews with the patient for input and instruction; assure patient understanding of who to contact when there is a problem; how to identify red flags, key self-management skills; assures delivery to the PCP
  • Contacts patients post discharge/ office/clinic visit to assess continued knowledge of disease, answers questions and assure that planned care and services are completed;  refers patients for additional services as need is identified
  • Participates in the development and presentation of disease management quality improvement reports for presentation to various committees and groups internally and externally.
  • Maintains appropriate documentation on activities/discussions with patients in the approved disease management record/system.
  • Develops and maintains excellent working knowledge of disease management/care management/healthcoaching skills and systems; stays abreast of current/upcoming enhancements to this field of knowledge; maintains excellent knowledge of disease state assigned



Schedule is typically Monday - Fridays, Days unless otherwise needed

Job Requirements

 MINIMUM Education:

  • Bachelor’s Degree in Nursing field; Master’s Degree strongly preferred.

 

MINIMUM WORK EXPERIENCE:

  • Minimum five 3-5 years experience in a related clinical nursing position.  Prior experience in disease management/care management/health coaching highly desirable.

 

KNOWLEDGE & SKILLS:

  • Demonstrated knowledge and experience in management of disease processes
  • Demonstrated knowledge of disease management/care management/health coach processes
  • Demonstrated ability to develop and employ effective patient teach back methods
  • Demonstrated knowledge of facilitating and coordinating patient care plans
  • Excellent oral, written, and interpersonal communication skills. Ability to work independently and also as a team with a wide variety of individuals; Excellent organizational skills
  • High degree of creativity in problem-solving; ability and patience to navigate and impact complex systems of care.
  • Proficient computer skills
  • Willingness to work some weekends

 

REQUIRED LICENSES, Certificates, Registrations:

  • Registered Nurse with current Illinois license required; Disease management certification desired

Location

1500 S. California Ave.

Department

Disease Management

Hours

Typically M-F Days, Unless otherwise needed

Shift

Days

Contact

Email resume to samantha.balaton@sinai.org with "Disease Management Nurse" in the subject line. You may also fax your resume to (773)257-6530.