Nurse Care Manager

Evergreen Nephrology Logo

Evergreen Nephrology

💵 $90k-$100k
📍Remote - Worldwide

Summary

Join Evergreen Nephrology as a Nurse Care Manager and make a difference in the lives of patients with kidney disease. You will manage a patient panel, providing clinical and emotional support, advocating for their needs, and coordinating their care with a team of physicians, APPs, and IDT members. This fully remote role requires strong communication, organizational, and problem-solving skills, as well as a passion for delivering high-quality, patient-centered care. You will be responsible for developing and implementing care plans, monitoring patient progress, and collaborating with other healthcare professionals to ensure seamless transitions of care. Evergreen offers a competitive salary, comprehensive benefits, and opportunities for professional development.

Requirements

  • Associate degree in nursing
  • Current RN License is required, Compact License preferred
  • Care management experience required
  • Able to work from 8:30am – 5pm in any time zone you indicate interest in
  • Intermediate skills with MS Office Suite of products including Outlook and Teams
  • Able to work effectively in a primarily remote environment
  • Home internet must support a minimum download speed of 25 Mbps and upload speed of 10 Mbps
  • Cable, Fiber, or DSL connections hardwired to the internet device are recommended
  • Evergreen will provide remote employees with telephony applications and equipment to meet the business requirements for their role
  • Employees must work from a dedicated space lacking ongoing interruptions to protect member PHI / HIPAA information

Responsibilities

  • Managing the overall care management of patient panel by leveraging experience, expertise, and knowledge in both the nursing field and value-based care operations
  • Establishing trusting and empathetic relationships with patients and families to provide clinical and emotional support and foster collaboration throughout their care journey
  • Serving as an advocate and community liaison for patients to ensure proper and timely resources and support while navigating the health care system and maintaining compliance with the primary care team’s/nephrologist’s treatment plan
  • Performing assessments and identifying the needs, including social determinants of health, of panel patients and caregivers based on values, care goals, and individual preferences, and translating these into patient-centric actionable care plans through comprehensive evaluations
  • Coordinating the interdisciplinary approach to achieving continuity of care and reducing fragmentation, focusing on kidney disease progression management, utilization management, and provider coordination through active care plan management
  • Monitoring and evaluating the effectiveness of care management plans regularly, modifying interventions as necessary
  • Following evidence-based care management guidelines and established workflow protocols to deliver high quality, efficient, patient-centered care that aligns with Evergreen’s goals, quality metrics, and regulatory and payer requirements
  • Collaborating with physician partners, community providers, APPs, and other clinical disciplines to create, implement, and manage integrated care plans
  • Identifying cost-effective measures for patients that support value-based care goals of improving patient outcomes and quality while effectively managing resource utilization
  • Facilitating patient and caregiver education on treatment options and empowering patients to make informed decisions about their care
  • Supporting seamless transitions of care as patients move between care settings, proactively addressing potential barriers and collaborating with IDTs
  • Actively participating in clinical huddles, and patient care conferences for patients under your care management as needed
  • Engaging in continuous, organizational process improvement to identify opportunities for improvement and execute action plans to optimize care management workflows, patient engagement processes, customer/patient care efforts, and other protocols
  • Preparing reports and other deliverables to communicate program changes or developments to appropriate stakeholders
  • Collecting data to prepare and deliver reports alongside program leaders on program success, patient outcomes, and patient/caregiver satisfaction
  • Other duties consistent with this role, as assigned

Preferred Qualifications

Certified Case Manager preferred

Benefits

  • Competitive base pay with bonuses
  • Paid time off starting at 4 weeks for full-time employees
  • 12 paid holidays per year
  • Medical, dental, vision and life insurance, including an HSA with employer match
  • Reimbursement for continuing medical education
  • 401(k) with match
  • Paid parental leave
  • A robust training and development program that starts with onboarding and continues throughout your career with Evergreen Nephrology

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