Description
We are a data-driven, performance-oriented healthcare organization dedicated to achieving operational excellence. Our mission is to make quality healthcare accessible, enhance patient health, and bring back the joy of practicing medicine for healthcare providers. By harnessing empathy, artificial intelligence, and predictive analytics, we utilize embedded Healthguides™ and a centralized Managed Service Organization to strengthen the connections between patients and providers. Our physician-led approach empowers partners to deliver high-quality healthcare focused on outcomes and value for all patients.
As an RN Case Manager, you will collaborate with clinical teams to provide comprehensive case management and enhance the relationship between patients and their primary care physicians or medical practice staff. You will support patients in achieving their highest level of wellness, focusing on those with complex medical conditions, socioeconomic factors, and mental health co-morbidities. Your role includes assessing, planning, implementing, coordinating, monitoring, and evaluating care options and services available to patients. You will work closely with a team of approximately five patient care navigators and other care team members to achieve optimal quality, clinical, and financial outcomes.
Location
This is a remote position with some travel required (10%-15%). Candidates should live or be willing to relocate within 90 minutes of Houston.
Key Responsibilities
- Conduct thorough assessments of patients' healthcare and psychosocial needs.
- Review and refine patient navigator interviews to ensure accurate and relevant information.
- Develop, implement, and maintain individualized care plans that comply with internal protocols and accreditation standards.
- Provide evidence-based clinical interventions aligned with individualized care plan goals.
- Collaborate with patient navigators to manage non-clinical aspects of care, such as scheduling appointments and arranging transportation or food services, addressing social determinants of health.
- Maintain ongoing communication with patients, continuously monitoring their data and adjusting care plans as necessary.
- Work with primary care providers to create specific escalation plans for managing chronic conditions during acute, non-emergent situations.
- Educate patients about their conditions and available treatment options.
- Advocate for patients and assist them in accessing services and resources requiring clinical expertise.
- Follow up on service or resource referrals.
- Keep documentation up to date in the electronic medical health record, following established protocols.
- Utilize evidence-based clinical protocols and guidelines along with defined quality metrics.
Qualifications
- Current, active license as a Registered Nurse in good standing.
- Minimum of 3 years of RN case management experience in an outpatient setting.
- Certification in Case Management (CCM) is preferred; must obtain CCM within one year of employment.
- Supervisory experience is a plus.
- Exceptional written and oral communication skills to engage empathetically with patients, families, and interdisciplinary teams.
- Proficient computer skills, including the ability to learn multiple electronic medical record (EMR) and case management documentation systems.
- Knowledge of accreditation and quality standards, including NCQA and HEDIS.
Preferred Qualifications
- Bilingual in English and Spanish.
Benefits
We prioritize your well-being and growth while you advance value-based healthcare. Our commitment to you includes:
- Remote Work: Enjoy the flexibility of working from home.
- Health Coverage: Comprehensive medical, dental, and vision plans.
- Retirement Planning: 401(k) plan with a 3% employer match.
- Peace of Mind: Life and disability insurance, along with optional voluntary life coverage.
- Support When Needed: Employee Assistance Program (EAP) for support during challenging times.
- Flexible Time Off: Tailored to meet your needs for a healthy work-life balance.
- Paid Parental Leave: Support for your growing family with paid leave.
- Learning and Development: Resources to help you advance your career.
Compensation
The base salary for this position ranges from \(80,000 to \)85,000 per year, paid bi-weekly. Final salary decisions will consider various factors, including experience, education, location, and licensure/certifications.
Equal Opportunity Employment
We are committed to diversity, inclusion, and belonging. We are an equal opportunity employer and make employment decisions without regard to race, religion, color, age, gender, sexual orientation, national origin, disability, or any other classification protected by law.
Security Responsibilities
This position is responsible for following all security policies and procedures to protect all patient health information (PHI) and intellectual property.
Employment Type: Full-Time