Care Manager RN

4 days ago

Pensacola, Florida, United States Monogram Health Full time
Job Title: Care Manager Registered Nurse

About the Role:

We are seeking a skilled Registered Nurse to join our team as a Care Manager. As a key member of our integrated Care Team, you will work closely with patients, medical providers, and other healthcare professionals to develop and implement personalized care plans.

Key Responsibilities:

  • Work with patients to develop and adapt care plans in collaboration with medical providers
  • Perform in-home care management visits to execute care plans and monitor patient progress
  • Inventory and reconcile medications, coordinate with pharmacists and prescribers, and perform patient health assessments and surveys as required
  • Deliver individual and group education on chronic kidney disease, end-stage renal disease, dialysis, and associated comorbidities
  • Encourage medication and treatment adherence through frequent contact with patients and engage family and social support groups in patient education and care
  • Provide education and coaching on medications, medical conditions, diet, exercise, and lifestyle choices, and facilitate conversations around proactive care decisions
  • Obtain vital signs during visits and escalate any concerns to the provider
  • Initiate patient relationships through enrollment and onboarding processes, and perform post-op and hospital discharge visits to support patients during vulnerable transitions
  • Review and document patient updates and progress in our care management platform, and coordinate with dialysis providers to ensure seamless transitions of care

Requirements:

  • Frequent local travel for in-home visits, with occasional domestic travel for training
  • Self-starter with ability to work independently with minimal supervision
  • Empathy and ability to build relationships with patients and physicians
  • Graduate of an accredited School of Nursing, currently licensed as a Registered Nurse in the state of employment, and 2+ years of experience in care management and/or with CKD/ESRD patients
  • Excellent verbal communication skills and familiarity with Microsoft Office and mobile phone and web-based applications

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. We strive to transform the way nephrology, primary care, and chronic condition treatment is delivered, prioritizing health equity and improving health outcomes for individuals with chronic kidney and end-stage renal disease.

Our Culture:

We believe in fostering an inclusive environment where employees feel encouraged to share their unique perspectives, leverage their strengths, and act authentically. We welcome individuals from all backgrounds and varying experiences to join our team and contribute to our mission.

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