Care Manager - Registered Nurse (RN)
Monogram Health · Tuscaloosa, AL · 3 wk ago
HybridHealthcareFull-time
Position Requirements
- Frequent local travel to perform in-home visits
- Basic Life Support (BLS) certification is required in this role
- The company will support your certification completion through onboarding
- Infrequent domestic travel may be required, primarily to Brentwood, TN for training
- Self-starter with the ability to work independently with minimal supervision
- 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
- Familiarity with Microsoft Office and mobile phone and web-based applications
Highlights & Benefits
- Flexible scheduling with a hybrid and in-home model
- Competitive compensation and a performance-based bonus program
- Full benefits package including medical, dental, vision, life insurance, 401(k) plan with matching contributions, paid vacation and holiday time
Roles And Responsibilities
- Work closely with patients’ medical providers 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 (business hours)
- Provide education and coaching around medications, medical conditions, diet, exercise, and lifestyle choices
- Encourage proactive care decisions, especially relating to Advance Care Plans and ESRD treatment modalities
- Obtain vital signs when visiting patient and escalate any concerns to the provider
- 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
- Cookordinate with dialysis providers to ensure transitions of care are seamless