Job Description: Care Manager - Registered NurseThe Care Manager RN is a key member of an integrated Care Team which includes an Advanced Practice Provider and a Social Worker. The patients we serve often struggle with multiple serious diseases. Registered Nurses help patients improve their quality of life in the home and slow the progression of kidney disease, enabling positive health outcomes.
Your Impact:As a Registered Nurse, you are an integral part of building trusting relationships with patients, so that they can experience a high quality of life at home. Work with a small panel of patients where you can directly experience the impact of your care. In healthcare systems, the patient has too often become secondary due to processes and incentives that don't positively impact the patient for the long term. Here at Monogram, we strive to change that narrative by putting our patients and their quality of life at the forefront of what we do.
Highlights & Benefits - Competitive compensation and a performance-based bonus program
- Full benefits package including medical, dental, vision, life insurance, 401(k) plan with matching contributions, paid vacation and holiday time
- The mid-range salary for this position is approximately $90,000, with final compensation dependent on experience and qualifications
Responsibilities- Work closely with patients' medical providers to develop and continually adapt care plan
- Perform in-home care management visits to execute care management plan
- Monitor biometric data and follow approved protocols for any necessary interventions
- Inventory and reconcile medications and coordinate with pharmacists and prescribers
- Perform patient health assessments and surveys as required
- Deliver individual and group education on CKD, ESRD, dialysis and associated comorbidities
- Encourage medication and treatment adherence through frequent contact with patients
- Engage family and social support groups in the education and care of patients
- Serve as the primary point of contact and be the first call when patients have questions (business hours)
- Provide education and coaching around medications, medical conditions, diet, exercise, and lifestyle choices
- Educate patients and facilitate conversations around proactive care decisions, especially relating to Advance Care Plans and ESRD treatment modalities
- Obtain vital signs when visiting patient and escalate any concerns to the provider
- Initiate patient relationships through enrolment and onboarding processes
- Perform post-op and hospital discharge visits to help patients through vulnerable transitions
- Review and document patient updates and progress in care management platform
- Coordinate with dialysis providers to ensure transitions of care are seamless
Position Requirements- Frequent local travel to perform in-home visits
- Basic Life Support (BLS) certification is required in this role. The company will support your certification completion through onboarding
- Infrequent domestic travel may be required, primarily to Brentwood, TN for training
- Self-starter with the ability to work independently with minimal supervision
- Ability to show empathy and quickly build relationships with patients and physicians
- Graduate of an accredited School of Nursing
- Currently licensed as a Registered Nurse in the State of the posted location
- 2+ years previous experience working in care management and/or with CKD/ESRD patients
- Ability to take call remotely on some nights and weekends
- Excellent verbal communication skills both in person and on the phone
- Familiarity with Microsoft Office and mobile phone and web-based applications
