About Us
We are a data-driven healthcare organization dedicated to operational excellence. Our mission is to provide affordable, quality healthcare, improve patient health, and enhance the experiences of healthcare providers. Utilizing empathy, artificial intelligence, and predictive analytics, we foster meaningful connections between patients and providers through our Healthguides™ and a centralized Managed Service Organization. Our physician-led approach empowers partners to deliver high-quality healthcare, emphasizing positive outcomes and value for all patients.
Position Overview
In this role, you will collaborate with clinical teams to offer comprehensive case management while strengthening the connection between patients and their primary care physicians. Your focus will be on assisting patients, particularly those with complex medical conditions and associated social, economic, or mental health challenges, in achieving their highest level of wellness. You will oversee the optimization of patient health through assessment, planning, implementation, coordination, monitoring, and evaluation of available services. Working closely with a team of patient care navigators and other healthcare professionals, you will aim for optimal quality, clinical, and financial outcomes for your patient population.
This is a remote position, with occasional travel required (10%-15%). Candidates should live or plan to live within 90 minutes of Houston.
What You'll Do
- Assess the healthcare and psychosocial needs of patients comprehensively.
- Review and refine patient navigator interviews with patients.
- Develop, implement, and maintain personalized care plans that adhere to 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, arranging transportation, and addressing social determinants of health.
- Maintain ongoing outreach to patients, continuously monitoring their data and adjusting care plans as needed.
- Work with primary care physicians to create specific escalation plans for managing acute but non-emergent exacerbations of chronic conditions.
- Educate patients about their conditions and available treatment options.
- Advocate for patients and assist them in accessing necessary services and resources.
- Follow up on referrals to services or resources.
- Ensure timely and accurate documentation in electronic health records as per established protocols.
- Utilize evidence-based clinical protocols and guidelines, along with defined quality metrics.
What You'll Need
- Active Registered Nurse license in good standing.
- 3+ years of RN Case Management experience in an outpatient setting.
- Certification in Case Management (CCM) preferred; must obtain within one year of employment.
- Supervisory experience preferred.
- Excellent written and verbal communication skills to engage empathetically with patients, families, and the interdisciplinary team.
- Proficient computer skills and the ability to learn various EMR and case management documentation systems.
- Ability to meet accreditation and quality standards, including NCQA and HEDIS.
Preferred Qualifications
- Bilingual in English and Spanish.
Benefits
We are committed to your well-being and growth as you advance value-based healthcare. Our offerings 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 6% contribution.
- Life and Disability Insurance: Options for added peace of mind.
- Employee Assistance Program (EAP): Support when you need it most.
- Flexible Time Off: Policies to help you achieve work-life balance.
- Parental Leave: Paid parental leave for family transitions.
- Professional Development: Resources dedicated to your learning 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 decisions will account for skill set, relevant experience, education, location, and licensure/certifications.
Commitment to Equal Opportunity Employment
We prioritize diversity, inclusion, and belonging. As an equal opportunity employer, we make employment decisions without regard to race, creed, color, age, sex, sexual orientation, identity, national origin, citizenship, religion, marital status, disability, military or veteran status, pregnancy, and childbirth. Our management is dedicated to upholding this policy in all aspects of employment.
Employment Type: Full-Time