The Care Manager RN will perform in-home visits to develop and adapt patient care plans while monitoring biometric data and medication adherence. They serve as the primary point of contact for patients, providing education on chronic conditions and facilitating transitions of care.
Requirements summary
Candidates must be a graduate of an accredited School of Nursing and hold a current Registered Nurse license in the state of the location. A minimum of 2 years of experience in care management or with CKD/ESRD patients and bilingual proficiency in English and Spanish are required.
Position: Bilingual care manager – registered nurse
Monogram Health is looking for skilled Registered Nurse eager for the opportunity to make a difference in patients' lives. The Care Manager RN is a key member of an integrated Care Team which includes an Advanced Practice Provider and a Social Worker. The patients we serve often struggle with multiple serious diseases. Registered Nurses help patients improve their quality of life in the home and slow the progression of kidney disease, enabling positive health outcomes.
Your impact
As a Registered Nurse, you are an integral part of building trusting relationships with patients, so that they can experience a high quality of life at home. Work with a small panel of patients where you can directly experience the impact of your care. In healthcare systems, the patient has too often become secondary due to processes and incentives that don’t positively impact the patient for the long term. Here at Monogram, we strive to change that narrative by putting our patients and their quality of life at the forefront of what we do.
Highlights & benefits
Relocation Bonus - Qualified candidates may be eligible for a comprehensive relation package, which may include assistance with moving expenses, temporary housing, and travel costs, in accordance with company policy.
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
Benefits
Dental insurance
Vision insurance
Paid vacation
Medical insurance
Life insurance
Competitive compensation
Paid holiday time
Performance-based bonus program
401(k) plan with matching contributions
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
Educate patients and facilitate conversations around 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
Coordinate with dialysis providers to ensure transitions of care are seamless
Position requirements
Must be bilingual (English/Spanish)
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
Ability to 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
Excellent verbal communication skills both in person and on the phone
Familiarity with Microsoft Office and mobile phone and web-based applications
About monogram health
Monogram Health is a leading multispecialty provider of in-home, evidence-based care for the most complex of patients who have multiple chronic conditions. Monogram health takes a comprehensive and personalized approach to a person’s health, treating not only a disease, but all of the chronic conditions that are present - such as diabetes, hypertension, chronic kidney disease, heart failure, depression, COPD, and other metabolic disorders.
Monogram Health employs a robust clinical team, leveraging specialists across multiple disciplines including nephrology, cardiology, endocrinology, pulmonology, behavioral health, and palliative care to diagnose and treat health issues; review and prescribe medication; provide guidance, education, and counselling on a patient’s healthcare options; as well as assist with daily needs such as access to food, eating healthy, transportation, financial assistance, and more. Monogram Health is available 24 hours a day, 7 days a week, and on holidays, to support and treat patients in their home.
Monogram Health’s personalized and innovative treatment model is proven to dramatically improve patient outcomes and quality of life while reducing medical costs across the health care continuum.
