Nurse Care Manager

Nurse Care Manager

Suvida Healthcare LLC Balch Springs, Texas, United States

Who We Are

At Suvida Healthcare, we are not just caregivers; we're compassionate advocates dedicated to enriching the lives of our cherished seniors. As a Team Member with us, you will embark on a fulfilling journey where your skills and empathy converge to make a meaningful impact on the well-being of an underserved community and their families. Our multi-disciplinary primary care program is built to address the physical, behavioral, social, and cultural needs of Medicare-eligible Hispanic seniors.

Celebrate diversity and inclusivity in a workplace that attracts, engages, values, rewards, and recognizes the unique needs and backgrounds of both, our patients and our team. We believe that a rich tapestry of experiences, shared interests, and perspectives enhances the care we provide, making us a stronger, service-centered, and more compassionate healthcare family and Employer of Choice! Will you join us Suvidanos, to help achieve our Higher Purpose?

What Makes Us Unique

We are an empowered primary care team, clinical operations, and support team creating health equity through an exceptional clinical and consumer experience that improves the quality of life for the people, families, and neighborhoods we serve. We tailor our primary care program to the culture, language, social, and overall well-being of the seniors we serve.

How We Work

Our Culture & Core Beliefs

Earn Trust Building Relationships Creating Joy Doing Right Improving Every Day Moving Forward

Our Promise

Purpose Driven Career Competitive Pay Best-In-Class Medical/Dental Coverage Free Mental Health & Life Coaching for Team Members and their Dependents Holiday Time Off with Pay Paid Community Service Day Paid Parental/Family Leave Paid Bereavement Leave Generous Paid Time Off (PTO)401k Retirement Plan with Company Match And much more....

What You’ll Do

Position Summary

The Nurse Care Manager will work with

Suvida

Healthcare’smultidisciplinary care team to provide high quality care for our high-risk patients.

Theywill collaborate with theirmultidisciplinaryneighborhood centercare team to develop organization-wide approaches to problem solving, tracking, and managing complex cases and populations. This nurse will need to plan effectively in order tomeet patient needs,identify social determinants of health, manage chronic conditions, and promote efficientutilizationof resources.

The Nurse Care Manager will implement

Suvida’scare pathwaysforpatients with chronic conditions.

Theywillalsooverseetransitions of care for patients to ensure safe transitions from acute to post-acute care, by coordinatingtimelyand cost-effective care.

The Nurse Care Manager will oversee highly complex and resource intense patients within their assigned care team.

They willcollaboratewith all providers, care team, patients,caregivers, payers, community resources, and external providers to promote quality of care.

Responsibilities

Oversees chronic care and transitions of care management of high-risk patients within their care teams and neighborhood centers Serves as a resource to the multidisciplinary team for the management of complex patients, including chronic care management assessments and care plans. Performs triage for patients via phone and addresses issues appropriately or forwards message to appropriatepartyfor further interventions. Responsible for ensuring efficient, organized patient transitions from acute and post-acute setting to home or other transitional care facility.

Perform comprehensive assessments for both physical, mental, and social risk factors that support individual patient needs whileidentifyingand addressing barriers. Collaborates with medical staff, nursing staff, and ancillary staff toeliminatebarriers to efficient delivery of care in the appropriate setting. Coordinates/facilitates patient care progression throughout the continuum. Collaborates with the physician and all members of the multidisciplinary team to facilitate care for designated patients;

monitors the patient’s progress, intervening as necessary and appropriate to ensure that the plan of care and services…