Clinical Case Manager/Physicians Group

18390 NCH ACO



8:00am - 5:00pm

None / Not Applicable

Bachelors Degree Required

The Clinical Case Manager provides coaching and diseases management services to identified populations. Facilitates comprehensive care planning and oversees data management to support process improvement. Supports evidence based practice and medical home/care coordination principles.



• Provide coaching and disease management services to identified populations> o Provides individual and/or group health coaching via telephone or in person.

o Manages patient populations, including care transitions.

o Uses adult learning principles to facilitate behavior change and patient empowerment.

o Collaborates with patient, caregivers, and providers to develop a comprehensive plan of care.

o Utilizes motivational interviewing to support patient self-management skills.

o Supports medical home and care coordination principles; follows/completes assigned activities/protocols.

o Participates in data collection/monitoring and formulation of process improvement plans.

o Conducts comprehensive assessments that identify behavioral, clinical, social, and environmental concerns and the needs of patients.

• Demonstrates sound clinical judgment. o Monitors patient's response to interventions and plans care appropriately.

o Identifies educational needs of patient/family and provides instruction/referrals to meet self-management goals.

o Identifies priorities and organizes work accordingly.

o Follows evidence based practices and standards of care.

• Planning/Consultation o Serves as an expert clinical leader within ambulatory clinics.

o Functions as a change agent using effective communication skills.

o Develops productive relationships with leaders, physicians, staff and community partners.

o Works collaboratively with other care team members to influence positive patient outcomes

o Supports team based care model.

o Maintains a case load consistent with program guidelines.


• Bachelor's Degree required. Candidate must hold a Bachelor's degree or enrolled in an accredited Bachelor's program resulting in successful graduation. (BSN or other Bachelor's Degree.)

• If RN, minimum of 2 years' experience required.

• Current RN licensure for the state of Florida is required with minimum of 2 years' experience.

• Basic Life Support from American Heart Association (BLS) required.

• Demonstrates competencies in nursing practice, with a focus on quality.

• Basic computer skills with excellent verbal and written communication skills.