Care Manager - Registered Nurse

Overview

Job Description:

Care Manager – Registered Nurse at Monogram Health. Monogram Health is looking for a skilled Registered Nurse eager for the opportunity to make a difference in patients  lives. The 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 k with a small panel of patients where you can directly experience the impact of your care. Monogram aims to put patients and their quality of life at the forefront of care.

• Flexible scheduling with a hybrid and in-home model
• 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

• Work closely with patients’ medical providers to develop and continually adapt care plans
• Perform in-home care management visits to execute the 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 patients 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 the care management platform
• Coordinate with dialysis providers to ensure transitions of care are seamless

• Frequent local travel to perform in-home visits
• Basic Life Support (BLS) certification is required; company will support certification on 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 of experience 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/web-based applications

Monogram Health is a leading multispecialty provider of in-home, evidence-based care for patients with multiple chronic conditions. Monogram Health employs a robust clinical team across nephrology, cardiology, endocrinology, pulmonology, behavioral health, and palliative care to diagnose and treat health issues, provide guidance and education, and assist with daily needs such as access to food, transportation, and financial assistance. Monogram Health is available 24/7 to support patients in their homes.

Its model aims to improve patient outcomes and quality of life while reducing medical costs across the health care continuum.

• Entry level

• Full-time

• Health Care Provider

• Hospitals and Health Care