Nurse Care Coordinator for Chronic Disease Management
7 days ago
About the Role:
This position involves working closely with patients' medical providers to develop and continually adapt care plans. The successful candidate will perform in-home care management visits, monitor biometric data, and coordinate with pharmacists and prescribers.
Key Responsibilities:
- Work with a small panel of patients to execute care management plans
- Monitor biometric data and follow approved protocols for necessary interventions
- Inventory and reconcile medications, coordinating 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
Requirements:
- Frequent local travel for in-home visits
- Infrequent domestic travel may be required 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 and currently licensed as a Registered Nurse
- 2+ years previous experience in care management and/or with CKD/ESRD patients
About Monogram Health:
We are a value-based chronic condition organization serving patients with chronic kidney and end-stage renal disease and their related metabolic disorders. Our mission is to transform the way nephrology, primary care, and chronic condition treatment is delivered. By increasing access to evidence-based care pathways and addressing social determinants of health, we aim to improve health outcomes while lowering medical costs.
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