About Us
We are a data-driven healthcare organization committed to operational excellence. Our mission is to make quality healthcare affordable, enhance patient health, and restore the joy of practicing medicine for healthcare providers. With a focus on empathy, advanced AI, and predictive analytics, we connect patients and providers through dedicated Healthguides™ and a centralized Managed Service Organization. Our physician-led approach empowers partners to deliver high-quality care centered on outcomes and value, both in and out of the exam room.
Position Overview
As an RN Case Manager, you will collaborate with clinical teams to provide comprehensive case management, strengthening the connection between patients and their primary care physicians or medical practice staff. Your role will focus on helping patients achieve their highest level of wellness by managing a specific population with complex medical conditions, socio-economic challenges, and/or mental health co-morbidities. You will optimize patient health through assessment, planning, implementation, coordination, monitoring, and evaluation of available options and services. You will work closely with a team of approximately five patient care navigators and other care team members to ensure the best quality, clinical, and financial outcomes.
This is a remote position requiring occasional travel (10%-15%). Candidates should live or be willing to relocate within 90 minutes of Houston. Thank you for your understanding.
Key Responsibilities
- Assess the healthcare and psychosocial needs of patients thoroughly.
- Review and update patient navigator interviews.
- Develop, implement, and maintain individualized care plans that comply with internal protocols and accreditation standards.
- Provide evidence-based clinical interventions aligned with the care plan goals.
- Partner with patient navigators to manage non-clinical aspects of care, such as scheduling appointments, arranging transportation or food services, and addressing social determinants of health.
- Conduct ongoing outreach to patients, continuously monitor patient data, and adjust care plans as needed.
- Collaborate with primary care providers to create specific escalation plans for non-emergency exacerbations of chronic conditions.
- Educate patients about their conditions and treatment options.
- Advocate for patients, assisting them in accessing and engaging with necessary services and resources.
- Follow up on service or resource referrals.
- Maintain accurate and up-to-date documentation in the electronic medical record as per protocols.
- Utilize evidence-based clinical protocols and guidelines alongside defined quality metrics.
Qualifications
- Licensed Registered Nurse in good standing.
- 3+ years of RN Case Management experience in an outpatient setting.
- CCM certification preferred; must obtain CCM within one year of employment.
- Supervisory experience preferred.
- Excellent written and verbal communication skills to empathetically interact with patients, families, and interdisciplinary teams.
- Proficient computer skills, including the ability to learn various EMR and case management documentation systems.
- Ability to meet accreditation and quality standards, including but not limited to NCQA and HEDIS.
Preferred Qualifications
- Bilingual in English and Spanish.
Benefits
While you work diligently to advance value-based healthcare, we prioritize your well-being and professional growth. Our commitments to you include:
- Work from Home: Enjoy the flexibility of a fully remote position.
- Health Coverage: Comprehensive Medical, Dental, and Vision plans.
- Retirement Planning: A 401(k) plan with a 3% employer match on your contributions.
- Peace of Mind: Life and Disability insurance for unexpected moments.
- Support When Needed: Access to our Employee Assistance Program (EAP).
- Work-Life Balance: Flexible Time Off to help you meet both personal and professional goals.
- Parental Support: Paid parental leave to support you as you welcome new family members.
- Learning and Development: A variety of resources dedicated to your professional growth and career advancement.
Compensation
The base pay range for this role is between \(80,000 and \)85,000 per year, paid bi-weekly. Final base pay will be determined based on various factors, including skill set, years of relevant experience, education, location, and licensure/certifications.
Our Commitment to Equal Opportunity Employment
We value diversity, inclusion, and belonging. As an equal opportunity employer, we make employment decisions without regard to race, color, age, sex, sexual orientation and identity, national origin, citizenship, religion, marital status, disability, military status, or any other classification protected by applicable laws. Our management is dedicated to ensuring fairness in hiring, placement, promotion, and all aspects of employment.
Security Commitment
This position requires adherence to all security policies and procedures to protect patient information and our intellectual properties.
Employment Type: Full-Time