Nurse Care Manager, Praxis Health

** Remote opportunity for residents of Oregon, Washington, and Idaho.**

The Nurse Care Manager supports patients through every stage of their healthcare journey by coordinating care, ensuring timely follow-up, and promoting evidence-based practices. This role bridges communication between patients, families, and providers to improve outcomes, reduce avoidable hospitalizations, and enhance patient satisfaction across Praxis Health clinics.

Compensation: $30-$37/hour, depending on experience

Schedule: Full-time;
Monday–Friday, 8-hour shifts, or four 9-hour shifts per week

Essential Duties and Responsibilities

The following essential job functions are intended to describe the general nature and level of work performed. They are not intended to be an exhaustive list of all responsibilities, duties, and skills required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

• Serve as a patient advocate and navigator, guiding patients and caregivers through the healthcare system.
• Review provider notes, discharge summaries, and clinical documentation to provide personalized patient education based on condition-specific knowledge and best practices.
• Complete emergency room and hospital follow-up calls, offering education on alternative access points (e.g., urgent care, same-day appointments, telehealth) to reduce avoidable ED visits.
• Perform comprehensive medication and allergy reconciliation with patients, caregivers, or facilities; verifying names, dosages, and frequencies per clinical protocols.
• Facilitate medication education and adherence support, including alignment with standing orders, protocols, and chronic disease management goals.
• Identify and support high-risk patients, including those with chronic conditions, frequent hospitalizations, or complex care needs, through proactive care coordination and outreach.
• Communicate clinical updates to Primary Care Providers (PCPs), ensuring timely follow-up appointments within the appropriate care windows.
• Coordinate continuity of care across settings (e.g., inpatient, outpatient, specialty, post-acute), including referrals and collaboration with external providers and facilities.
• Collaborate with interdisciplinary care teams, including primary care, chronic care management, and the Quality department, to identify barriers to care and improve care delivery.
• Actively participate in system-wide quality and population health initiatives, including but not limited to:
  • Medication adherence programs
  • Statin use monitoring
  • High-cost care management
  • Emergency department utilization reduction
  • Advance care planning
  • Reduction in readmission
• Monitor daily reports and EHR-based alerts to identify patients in need of outreach or follow-up based on clinical risk or recent utilization.
• Maintain timely, complete, and compliant documentation of all patient interactions, care coordination activities, lab orders, charges, and communications within the EHR.
• Coordinate patient documentation needs, including requesting and organizing medical records in compliance with organizational and regulatory standards.
• Promote effective communication across care teams, ensuring awareness of care plans, follow-up needs, and changes in clinical status.
• Evaluate care delivery processes and contribute to the development and refinement of workflows, tools, and procedures to support quality and efficiency.
• Participate in internal and external improvement initiatives, collaborative partnerships, and payor-aligned programs focused on patient outcomes and system performance.
• Support onboarding and mentoring of clinical team members as appropriate to experience and licensure.
• Complete assigned EHR tasks and responsibilities accurately and on time, as delegated by leadership.
• Maintain compliance with state licensure requirements and practice within the legal scope of the RN or LPN, as applicable.
• Stay current with required continuing education, certifications, and competencies.
• Adhere to all HIPAA, privacy, and security standards, as well as organizational policies.
• Demonstrates a consistently professional, respectful, and constructive attitude in all interactions. Fosters a positive, team-oriented work environment by building trust, encouraging collaboration, and communicating effectively with team members, clients, and leadership.
• Maintain professionalism, adaptability, and respect in all interactions to support a positive, team-oriented work environment.
• Demonstrates professionalism,…