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Patient Care Coordinator
2 months ago
You are a dedicated and empathetic professional who thrives in the healthcare environment, making a significant impact on the lives of your patients. Your commitment lies in understanding the underlying causes of health issues, addressing social determinants of health, and ensuring optimal quality of life and outcomes for those under your care. You believe that individuals with kidney disease deserve comprehensive, patient-centered care and are eager to influence the healthcare landscape towards this goal. You prioritize quality over quantity, offering the same level of care and dedication to your patients and team as you would to your own family. You excel in dynamic and innovative settings that embrace change and are motivated by continuous improvement. Does this resonate with you? If so, we would like to connect.
About Us
Evergreen Nephrology collaborates with nephrologists to revolutionize kidney care through a value-driven, patient-centered, and holistic approach. We are dedicated to enhancing patient outcomes and improving quality of life by delaying disease progression, facilitating home care, and expediting kidney transplants.
We empower nephrologists to focus on the right patients at the right time throughout the entire care continuum. This is achieved by equipping them with top-tier interdisciplinary clinical resources, analytical insights, and patient services.
We actively listen to the needs of our patients, employees, and partners, continuously striving to exceed the current standards of patient management.
Your Responsibilities
As a Nurse Care Manager at Evergreen Nephrology, you will work alongside a team of Physicians, Advanced Practice Providers, and interdisciplinary members to manage a designated patient panel, addressing the unique needs of each individual based on their specific health conditions. Your key responsibilities will include:
- Establishing strong, empathetic relationships with patients and their families.
- Assessing and identifying patient needs according to their values, goals, and preferences, and translating these into clinical requirements.
- Collaborating with Nephrology Partners, Primary Care Physicians, Advanced Practice Providers, Specialists, and various disciplines to develop comprehensive case management plans.
- Working with the Nephrologist partner/APP to implement care plans by coordinating access to health services across multiple providers and disciplines.
- Monitoring care and identifying cost-effective solutions, including recommendations for alternative care levels and resource utilization.
- Coordinating patient education (including family involvement as appropriate) regarding treatment options and advocating for access to preferred treatments.
- Evaluating the effectiveness of case management plans based on quality and cost metrics, making adjustments as necessary.
- Coordinating an interdisciplinary approach to ensure continuity of care, including management of kidney disease progression and necessary outside services for patients and families.
- Acting as a clinical liaison with external agencies, including County CCS, non-plan facilities, outside providers, employers, and third-party administrators.
- Preparing reports, communicating program changes to relevant staff, and developing protocols in line with compliance requirements.
- Facilitating effective transitions of care when appropriate.
- Engaging internal resources to address Social Determinants of Health, such as transportation, housing stability, and food security.
- Participating in data collection, formulation, implementation, and monitoring of action strategies and care outcomes.
- Maintaining accurate records of care associated with each patient.
- Interpreting regulations, health plan benefits, policies, and procedures for members, physicians, medical office staff, contract providers, and external agencies.
- Actively participating in team huddles, interdisciplinary team sessions, and patient case conferences.
- Representing Evergreen with professionalism to patients, their families, and the community.
- You resonate with our values and are excited about contributing to our innovative culture.
- You are adaptable and thrive in a fast-paced, evolving environment.
- A current RN License is required; a BSN is preferred.
- A compact license is preferred, with a strong preference for RNs based in TX, KY, or FL.
- 1+ years of experience in utilization management is preferred.
- 3+ years of clinical experience in a hospital, clinic, home care, or nursing home setting is highly desirable.
- Experience in case management and CCM certification is preferred but not mandatory.
- Experience in disease management and/or physician office settings is beneficial.
The compensation range for this role is between $90,000 and $100,000, with the exact salary determined by experience, education, demand for the role, and other relevant criteria.
Support and Development
- Evergreen Nephrology offers a comprehensive total rewards package, including competitive base pay with bonuses, generous paid time off starting at four weeks for full-time employees, 12 paid holidays annually, reimbursement for continuing education, a 401k plan with matching contributions, and health, dental, and vision insurance.
- We are committed to family-friendly policies, including paid parental leave and flexible work arrangements.
- Our robust training and development program begins with onboarding and continues throughout your career with Evergreen Nephrology.
- As part of an inclusive and diverse team, you will collaborate with like-minded healthcare professionals who value high-quality, patient-centered care.
