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 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.

As a Registered Nurse, you are integral to building trusting relationships with patients so that they can experience a high quality of life  will work with a small panel of patients, directly experiencing the impact of your care, and change the healthcare narrative by putting patients and their quality of life at the forefront.

• 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 care management plans
• 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 elevate any concerns to the provider
• Initiate patient relationships through enrollment 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 required; the company will support 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 calls 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

Monogram Health is a leading multispecialty provider of in‑home, evidence‑based care for complex patients with multiple chronic conditions. We employ a robust clinical team with specialists across nephrology, cardiology, endocrinology, pulmonology, behavioral health, and palliative care to diagnose and treat health issues, prescribe medication, and provide guidance, education, and counselling.

Entry level

Full‑time

Health Care Provider

Hospitals and Health Care