Care Manager - Registered Nurse

Care Manager – Registered Nurse

Monogram Health is looking for a skilled Registered Nurse eager to make a difference in patients’ lives. The Care Manager RN is a key member of an integrated Care Team that includes an Advanced Practice Provider and a Social Worker. The patients we serve struggle with multiple serious diseases and the RN helps improve their quality of life at home and slow the progression of kidney disease, enabling positive health outcomes.

As a Registered Nurse, you build trusting relationships with patients, enabling them to experience a high‑quality life king with a small panel of patients, you can directly witness the impact of your care and help shift the narrative in healthcare toward patient‑centric long‑term outcomes.

• Flexible scheduling with a hybrid and in‑home model
• Competitive compensation and 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 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 during business hours when patients have questions
• 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 during patient visits and elevate concerns to the provider
• Initiate patient relationships through enrolment and onboarding processes
• Perform post‑op and hospital discharge visits to aid patients through vulnerable transitions
• Review and document patient updates and progress in the care‑management platform
• Coordinate with dialysis providers to ensure seamless transitions of care

• Frequent local travel to conduct in‑home visits
• Basic Life Support (BLS) certification required; the company supports completion during 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 prior experience in care management and/or with CKD/ESRD patients
• Availability 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/web‑based applications

Monogram Health is a leading multispecialty provider of in‑home, evidence‑based care for complex patients with multiple chronic conditions. Through a comprehensive and personalized approach, we treat not only a single disease but all chronic conditions present—such as diabetes, hypertension, chronic kidney disease, heart failure, depression, COPD, and other metabolic disorders. Our team of specialists across nephrology, cardiology, endocrinology, pulmonology, behavioral health, and palliative care collaborates to diagnose, prescribe, and educate patients.

We are available 24 hours a day, 7 days a week, and on holidays to support and treat patients in their homes. Our innovative model dramatically improves patient outcomes and quality of life while reducing costs across the health‑care continuum.