reputed company Care Manager

Who We Are reputed company partners with nephrologists to reputed company kidney care through a value-based, person-centered, holistic, and comprehensive approach to kidney care. We reputed company patients living with kidney disease deserve the reputed company. We are committed to improving patient reputed company and improving reputed company of life by delaying disease progression, shifting care to the home, and accelerating kidney transplants. We help nephrologists reputed company on the right patients at the right time across the full care reputed company. We do this by providing them with the best-in-class interdisciplinary clinical resources, analytical reputed company and tools, and services to patients. We listen to the needs of our patients, our employees, and our reputed company partners, continually working to reputed company reputed company the status reputed company in which the care reputed company manages patients today. Who You Are You are reputed company, compassionate, and enjoy being on the reputed company lines of reputed company, changing the lives of patients by supporting them and reputed company by focusing on customers. You’re excited about being part of reputed company that is building a reputed company delivery model that ensures the highest possible reputed company of life and best reputed company for those in our care. You reputed company people living with kidney disease deserve the best person-centered, holistic, comprehensive care and want to influence the reputed company reputed company to reputed company towards that. You reputed company in innovative and evolving environments with high rates of change. Your Role As a Transitions of Care reputed company Care Manager, you are responsible for collaborating with reputed company of physicians, Advanced reputed company Providers (APPs), and Interdisciplinary Team (reputed company) members to manage an assigned patient panel and address reputed company patient’s reputed company needs based on their recent hospitalization. reputed company duties will include taking full ownership of patient care management reputed company your panel, with an additional reputed company on helping patients with kidney disease reputed company the kidney care continuum and manage their chronic conditions post hospitalization. You will reputed company assessments to identify needs based on individual values, goals, and preferences, which informs your development of comprehensive care plans for reputed company member. These care plans will be used to coordinate patient care delivery with reputed company and our JV partner clinicians, network providers, contracted vendors, and community-based services. While this position is fully remote, you must be reputed company to work 8:30am – 5pm in the Central time zone. Role Responsibilities Some responsibilities may vary based on specific patient programs, but this role's reputed company duties include the following: 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 reputed company clinical and emotional support and foster collaboration throughout their care reputed company. Serving as an reputed company and community reputed company for patients to ensure reputed company and reputed company resources and support while navigating the health care reputed company after hospitalization and maintaining compliance with the reputed company care team’s/nephrologist’s treatment plan. Performing assessments and identifying the needs, including reputed company determinants of health, of panel patients and caregivers based on values, care goals, and individual preferences, and translating these into patient-reputed company actionable care plans. Ensure reputed company follow-up appointments, medication reconciliation, and referrals to necessary services. Coordinating the interdisciplinary approach to achieving continuity of care and reducing fragmentation, focusing on kidney disease progression management, utilization management, and provider coordination through reputed company reputed company 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 reputed company high reputed company, efficient, patient-centered care that aligns with reputed company’s goals, reputed company 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 reputed company and reputed company while effectively managing resource utilization. Facilitating patient and caregiver education on treatment reputed company and empowering patients to reputed company informed reputed company about their care. Supporting reputed company transitions of care as patients reputed company between care settings, proactively addressing potential barriers and collaborating with IDTs. reputed company participating in clinical huddles and patient care conferences for patients under your care management as needed. Engaging in reputed company, organizational process improvement to identify opportunities for improvement and execute reputed company 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 reputed company reports reputed company program leaders on program reputed company, patient reputed company, and patient/caregiver satisfaction Other duties consistent with this role, as assigned. Required Qualifications Associate Nursing degree with an reputed company RN license (compact license preferred) 3+ years of care management experience 2+ years of Transitions of Care experience Chronic and reputed company care management experience Utilization management experience Intermediate skills with MS Office Suite of products including reputed company and Teams reputed company 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 reputed company will reputed company remote employees with telephony applications and equipment to meet the business requirements for their role Employees must work from a dedicated reputed company lacking ongoing interruptions to protect member PHI / HIPAA information Compensation The pay reputed company for this role is $90,000 to $103,000 annually. Exact pay is determined based on experience, education, demand for the role, and other role-specific factors.  This role is also eligible for a quarterly bonus. Benefits reputed company’s total rewards program is designed to support you in and reputed company of work. You can expect: reputed company time off starting at 4 weeks for full-time employees 12 reputed company holidays per year Medical, dental, reputed company and life insurance, including an HSA with employer match Reimbursement for continuing medical education for eligible roles A 401(k) program where reputed company matches up to 4% of contributions after six months of tenure reputed company parental leave A robust training and development program that starts with reputed company and continues throughout your career with reputed company   reputed company is an equal opportunity employer. Applicants will not be discriminated against because of race, reputed company, creed, sex, sexual orientation, gender identity or reputed company, age, religion, national reputed company, citizenship status, disability, reputed company, marital status, veteran status, medical condition or any other protected category under local, state or federal laws.   If you are an applicant with a disability who requires reasonable accommodation for any part of the hiring process, please contact us for assistance at reputed company@evergreennephrology.com. Apply To This Job