Nurse Care Manager

Overview

Required skills and experience: - Current RN License is required, BSN preferred. · 1+ years of utilization management experience preferred. · 3+ years of clinical practice in a hospital, clinic, home care, or nursing home setting highly · Case management experience and CCM preferred but not required. · Disease management and/or physician office experience · You accept that things change quickly in a startup environment and are willing to pivot quickly on priorities What you need to know: As a Nurse Care Manager with our company , you will collaborate with team of Physicians, Advanced Practice Providers, and interdisciplinary team members to manage an assigned patent panel and address patient's specialized needs based on their individual conditions. Your job duties will include taking full ownership of patients within your panel, with additional focus on helping patients with kidney disease navigate the kidney care continuum and manage all their additional chronic conditions. You will perform assessments to identify their needs based on their values, goals and preferences. From this assessment, you will develop comprehensive care plans for each member. These care plans will be used to coordinate patient care delivery with our company and our JV partner clinicians, network providers, contracted vendors, and community-based services. Primary functions for the Nurse Care Manager include: · Quickly build empathetic relationships with patients and families · Evaluate and identify patient’s needs based on their respective values, goals, and preferences, then translates these needs into clinical needs · Interface with Nephrologist Partners, Primary Care Physicians, Advanced Practice Providers, Specialists, and various disciplines on the development of case management plans/programs · In conjunction with the Nephrologist partner/APP, implement care/treatment plan by coordinating access to health services across multiple providers/ disciplines · Monitor care and identify cost-effective measures, including recommendations for alternative levels of care and utilization of resources · Effectively coordinate patient education (including family involvement as appropriate) regarding treatment options, and advocate for access to the preferred treatment option · Monitor and evaluate the effectiveness of the case management plans based on quality and cost drivers and modifies as necessary · Coordinate the interdisciplinary approach to providing continuity of care, including kidney disease progression management, utilization management, kidney care coordination, needed for outside services for patients/families · Act as a clinical liaison, per their specialty, with outside agencies such as County CCS, non-plan facilities, outside providers, employers and/or workers' compensation carriers and third-party administrators · Prepare reports, communicate program changes to appropriate staff and develop protocols in accordance with compliance requirements · Coordinate and advocate for effective transition of care when appropriate/needed · Engage internal resources to identify and respond to Social Determinants of Health such as lack of transportation, stable housing, or food resources · Participate in the data collection, formulation and implementation and monitoring of action strategies and outcomes of care or customer service · Ensure that accurate records are maintained of the care associated with each patient · Interpret regulations, health plan benefits, policies, and procedures for members, physicians, medical office staff, and contract providers and outside agencies · Actively participate in huddles, IDT sessions, and patient case conferences · Commendably represent Evergreen to patients, their families, and the community

Qualifications

• Bachelor's degree or higher
• Valid RN in California (CA)
• 3+ years of experience in ANY of the following:
  • Clinical Practice in a Hospital
  • Clinic Care
  • Home care
  • Nursing Home Care
• Are you comfortable working in a start-up environment?
• Are you comfortable working in the downtown San Diego area?

• Do you hold a CCM?

Benefits

Company

Our client is a Hospital & Healthcare Company who partners with nephrologists to transform kidney care and improve patient outcomes. They believe that patients living with kidney disease deserve the best care and they are passionate about making an impact. When nephrologists are empowered, they are enabled to transform kidney care for their patients and partner with their patients on earlier identification of alternative modalities, slowing of disease progression, improved clinical outcomes, and increased quality of life.