Care Manager

3 weeks ago

New Holland PA United States MH Renal Services MSO LLC Full time

Position: Care Manager - Registered Nurse

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 at home. Work with a small panel of patients where you can directly experience the impact of your care.

At Monogram Health, our mission is to transform the way health care is delivered for those with kidney disease so they can lead healthier, happier, and more fulfilling lives.
This transformation is urgently needed. In our healthcare system, the patient has too often become secondary due to processes and incentives that don't positively impact the patient for the long term.
The Care Manager - RN is a key member of an integrated Care Team which includes a 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.

Roles and Responsibilities
Work closely with patients' nephrologists to develop and continually adapt care plan
Perform in-home care management visits to execute 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
Provide education and coaching around diet, exercise, and lifestyle choices
Educate patients and facilitate conversations around proactive care decisions, especially relating to transplantation, home modalities and proactive AV fistula placement
Obtain vital signs when visiting patient and escalate any concerns to the nephrologist
Facilitate nephrologist contact with other physicians to ensure comorbidities are managed
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 care management platform
Coordinate with dialysis providers to ensure transitions of care are seamless
Position Requirements
Infrequent domestic travel may be required, primarily to Brentwood, TN
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 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 and web-based applications
Benefits
Opportunity to work in a dynamic, fast-paced and innovative value-based provider organization that is transforming the delivery of kidney care
Competitive salary
Comprehensive medical, dental, vision and life insurance
Flexible paid leave and vacation policy
401(k) plan with matching contributions
About Monogram Health

Monogram Health is a value-based chronic condition organization serving patients with chronic kidney and end-stage renal disease and their related metabolic disorders. Monogram seeks to transform the way nephrology, primary care and chronic condition treatment is delivered. Monogram's in-home approach utilizes a national nephrology practice supported by case and disease management, utilization management and review, and medication therapy management services that improve health outcomes while lowering medical costs. By increasing access to evidence-based care pathways and addressing social determinants of health, Monogram has emerged as an industry leader in championing health equity and improving health outcomes for individuals with chronic kidney and end-stage renal disease.

  • Care Manager

    2 weeks ago

    New Holland, United States MH Renal Services MSO LLC Full time

    Position: Care Manager – Registered NurseAs a Registered Nurse, you are an integral part of building trusting relationships with patients, so that they can experience a high quality of life at home. Work with a small panel of patients where you can directly experience the impact of your care.At Monogram Health, our mission is to transform the way health...

  • Case Manager

    3 weeks ago

    Harrisburg, PA, United States All American Home Care LLC Full time

    Providing coordinated care to patients by developing, monitoring, and evaluating their home health care plans. · Ensure a high level of care for the patient given by the home health aides. · Scheduling agency home health care aides accordingly and ensuring agency aides work their scheduled shift. · Managing last minute calls outs, finding appropriate...

  • Medical Care Specialist

    1 week ago

    Holland, United States Abode Care Partners Full time

    About the RoleWe are seeking a compassionate Nurse Practitioner to join our team at Abode Care Partners, a leading provider of integrated medical services. The successful candidate will be responsible for delivering high-quality patient care in various settings, including skilled nursing facilities, assisted living, independent living, group homes, and...

  • Medical Care Specialist

    1 week ago

    Holland, United States Abode Care Partners Full time

    About the RoleWe are seeking a skilled Medical Care Specialist to join our team at Abode Care Partners, providing high-quality healthcare services to seniors and individuals with complex needs. As a key member of our interdisciplinary care team, you will work closely with healthcare professionals to deliver personalized care management plans.

  • RN Care Manager

    4 weeks ago

    Philadelphia, PA, United States Spectrum Health Services Full time

    RN Care ManagerEssential Functions: Provides Care Management Services * Identify patients at high risk of adverse health outcomes (e.g., death, disability, inpatient admission, SNF admission or ED visit) through case finding activities including physician referrals, hospital/ED utilization data, payor reports, claims, or encounter data review identifying...

  • RN Care Manager

    4 weeks ago

    Philadelphia, PA, United States Spectrum Health Services Full time

    RN Care ManagerEssential Functions: Provides Care Management Services * Identify patients at high risk of adverse health outcomes (e.g., death, disability, inpatient admission, SNF admission or ED visit) through case finding activities including physician referrals, hospital/ED utilization data, payor reports, claims, or encounter data review identifying...

  • Nurse Care Manager in New Holland

    4 days ago

    New Holland, Pennsylvania, United States Provider Healthcare Full time

    Job Description"> The role of a skilled Team Nurse is available at our New Holland, Pennsylvania-based client. The ideal candidate is a self-motivated leader with excellent clinical skills who practices within the Share the Care model and is a collaborative team member.This position involves collaboration with clinicians, LPNs, MAs, social work, behavioral...

  • RN Ambulatory Care Manager Holland

    1 week ago

    Holland, United States Corewell Health Full time

    About Outpatient ClinicsCorewell Health operates over 300 outpatient clinics across Michigan, bringing a multitude of care options to the communities that we serve. There are over 40 different types of primary care and specialty practices, which allows those who work in these clinics the opportunity to learn and explore various interests or to specialize in...

  • RN Ambulatory Care Manager Holland

    1 week ago

    Holland, United States Spectrum Health Full time

    About Outpatient Clinics Corewell Health operates over 300 outpatient clinics across Michigan, bringing a multitude of care options to the communities that we serve. There are over 40 different types of primary care and specialty practices, which allows those who work in these clinics the opportunity to learn and explore various interests or to...

  • RN Care Manager

    2 weeks ago

    Philadelphia, PA, United States Strive Health Full time

    RN Care Manager - (Evergreen)What We Strive For At Strive Health, we're driven by a purpose: transforming the broken kidney care system. Through early identification, engagement, and comprehensive coordinated care, we significantly improve outcomes for people with kidney disease, reducing emergency dialysis and inpatient utilization. Our high-touch care...

  • RN Care Manager

    4 months ago

    Philadelphia, PA, United States Strive Health Full time

    RN Care Manager - (Evergreen)What We Strive For Strive Health is built for purpose - to transform a broken kidney care system. We are fundamentally changing the lives of people with kidney disease through early identification, engagement and comprehensive coordinated care. Strive's model is driven by a high-touch care team that integrates with local...

  • RN Care Manager

    3 months ago

    Philadelphia, PA, United States Strive Health Full time

    RN Care Manager - (Evergreen)What We Strive For Strive Health is built for purpose - to transform a broken kidney care system. We are fundamentally changing the lives of people with kidney disease through early identification, engagement and comprehensive coordinated care. Strive's model is driven by a high-touch care team that integrates with local...

  • Care Manager RN

    5 months ago

    Philadelphia, PA, United States Monogram Health Full time

    Care Manager RN - Philadelphia, PAPosition: Be a Care Manager - Registered Nurse at Monogram! "I have never felt more supported by a company!" "Management is always shouting out employees for the wins they are doing for their patients. You can see the passion that everyone has for these patients. It really does feel like a team. I was very nervous walking...

  • Care Manager, RN

    3 months ago

    Philadelphia, PA, United States Monogram Health Full time

    Care Manager, RN - Philadelphia, PAPosition: Be a Care Manager - Registered Nurse at Monogram! "I have never felt more supported by a company!" "Management is always shouting out employees for the wins they are doing for their patients. You can see the passion that everyone has for these patients. It really does feel like a team. I was very nervous walking...

  • RN Care Manager

    3 days ago

    Milwaukee, WI, United States Community Care, Inc. Full time

    W. Vliet Street - Milwaukee County, 3220 West Vliet Street, Milwaukee, Wisconsin, United States of America Req #2846 Friday, November 15, 2024 RN Care Manager - Full-Time - Day Shift Community Care is hiring a RN Care Manager to join our Partnership Program team. This rewarding opportunity is perfect for someone who enjoys team collaboration, community case...

  • Care Manager

    2 weeks ago

    Kingston, NY, United States Care Design New York Full time

    Overview: As a Care Design New York Care Manager, you will help people with intellectual and/or development disabilities identify and realize their long-term and short-term goals by developing, implementing, and monitoring their person-centered Life Plans. These plans help our members live their best life - so we'll count on your best relational and...

  • RN Care Manager II, Member Support

    2 weeks ago

    Philadelphia, PA, United States Amerihealth Caritas Health Plan Full time

    RN Care Manager II, Member SupportYour career starts now. We are looking for the next generation of health care leaders. At AmeriHealth Caritas, we are passionate about helping people get care, stay well and build healthy communities. As one of the nations leaders in health care solutions, we offer our associates the opportunity to impact the lives of...

  • RN Care Manager II, Member Support

    3 weeks ago

    Philadelphia, PA, United States Amerihealth Caritas Health Plan Full time

    RN Care Manager II, Special Needs, BSN (must reside within 30 minutes Philadelphia County, PA)Your career starts now. We are looking for the next generation of health care leaders. At AmeriHealth Caritas, we are passionate about helping people get care, stay well and build healthy communities. As one of the nations leaders in health care solutions, we offer...

  • Nurse Care Manager, Integra

    3 days ago

    , RI, United States Care New England Health System Full time

    The Integra Transitions NCM collaborates with hospitals and skilled nursing facilities to pursue cost-effective, quality-focused management interventions by achieving predetermined financial and clinical outcomes. Responsible for collaboration with the Integra Nurse Care Managers/Transition Managers (hospital and skilled nursing facility based) concerning...

  • Care Manager

    2 weeks ago

    Central Islip, NY, United States Care Design New York Full time

    Overview: As a Care Design New York Care Manager, you will help people with intellectual and/or development disabilities identify and realize their long-term and short-term goals by developing, implementing, and monitoring their person-centered Life Plans. These plans help our members live their best life - so we'll count on your best relational and...