Care Manager - Registered Nurse

Monogram Health, Inc.; Trenton (NJ); On-site; USD 80,000 - 100,000; Full time

Benefits offered by this job

Competitive compensation

Performance-based bonus

Full benefits package (medical, dental

Job summary

Monogram Health is seeking a skilled Registered Nurse to join our Care Management team as a Care Manager RN. You will lead in-home care for a small panel of CKD/ESRD patients, coordinating with physicians, pharmacists, and social workers to slow disease progression and improve quality of life.

The role requires BLS, RN licensure in the posted state, and 2+ years in care management, with local travel and some nights/weekend on-call. Competitive pay and comprehensive benefits provided.

Qualifications

• Graduate of an accredited School of Nursing.
• Currently licensed as a Registered Nurse in the state of the posted location.
• 2+ years experience in care management and/or with CKD/ESRD patients.
• BLS certification required; company will support certification on onboarding.
• Frequent local travel for in-home visits; on-call some nights and weekends.

Responsibilities

• Work closely with patients’ medical providers to develop and continually adapt care plan.
• Perform in-home care management visits to execute care management plan.
• Monitor biometric data and follow approved protocols for any necessary interventions.
• Inventory and reconcile medications and coordinate with pharmacists and prescribers.
• Perform patient health assessments and surveys as required.
• Deliver education on CKD, ESRD, dialysis and related comorbidities.
• Encourage medication adherence through frequent contact with patients.
• Engage family and social support groups in patient education and care.
• Serve as the primary contact and be the first call during business hours.
• Provide education around medications, conditions, diet, exercise, and lifestyle decisions.
• Educate patients and facilitate Advance Care Plans and ESRD treatment discussions.
• Obtain vital signs during visits and escalate concerns to the provider.
• Onboard patients and manage enrollment processes.
• Perform post-op and hospital discharge visits to support transitions.
• Review and document patient progress in the care management platform.
• Coordinate with dialysis providers to ensure seamless transitions of care.

Skills

Empathy and relationship-building

Excellent verbal communication

Self-starter with independence

In-home visit readiness

Education

Graduate of an accredited School of Nursing

Tools

Microsoft Office

Job description

Job Description: Care Manager – Registered Nurse

Monogram Health is looking for skilled Registered Nurse eager for the opportunity to make a difference in patients' lives. The Care Manager RN is a key member of an integrated Care Team which includes an Advanced Practice Provider and a Social Worker. The patients we serve often struggle with multiple serious diseases. Registered Nurses help patients improve their quality of life in the home and slow the progression of kidney disease, enabling positive health outcomes.

Your Impact:

As a Registered Nurse, you are an integral part of building trusting relationships with patients, so that they can experience a high quality of life at home. Work with a small panel of patients where you can directly experience the impact of your care. In healthcare systems, the patient has too often become secondary due to processes and incentives that don’t positively impact the patient for the long term. Here at Monogram, we strive to change that narrative by putting our patients and their quality of life at the forefront of what we do.

Highlights & Benefits

• Competitive compensation and a performance-based bonus program
• Full benefits package including medical, dental, vision, life insurance, 401(k) plan with matching contributions, paid vacation and holiday time
• The mid‑range salary for this position is approximately $90,000, with final compensation dependent on experience and qualifications

Responsibilities

• Work closely with patients’ medical providers to develop and continually adapt care plan
• Perform in-home care management visits to execute care management plan
• Monitor biometric data and follow approved protocols for any necessary interventions
• Inventory and reconcile medications and coordinate with pharmacists and prescribers
• Perform patient health assessments and surveys as required
• Deliver individual and group education on CKD, ESRD, dialysis and associated comorbidities
• Encourage medication and treatment adherence through frequent contact with patients
• Engage family and social support groups in the education and care of patients
• Serve as the primary point of contact and be the first call when patients have questions (business hours)
• Provide education and coaching around medications, medical conditions, diet, exercise, and lifestyle choices
• Educate patients and facilitate conversations around proactive care decisions, especially relating to Advance Care Plans and ESRD treatment modalities
• Obtain vital signs when visiting patient and elevate any concerns to the provider
• Initiate patient relationships through enrolment and onboarding processes
• Perform post-op and hospital discharge visits to help patients through vulnerable transitions
• Review and document patient updates and progress in care management platform
• Coordinate with dialysis providers to ensure transitions of care are seamless

Position Requirements

• Frequent local travel to perform in-home visits
• Basic Life Support (BLS) certification is required in this role. The company will support your certification completion through onboarding
• Infrequent domestic travel may be required, primarily to Brentwood, TN for training
• Self-starter with the ability to work independently with minimal supervision
• Ability to show empathy and quickly build relationships with patients and physicians
• Graduate of an accredited School of Nursing
• Currently licensed as a Registered Nurse in the State of the posted location
• 2+ years previous experience working in care management and/or with CKD/ESRD patients
• Ability to take call remotely on some nights and weekends
• Excellent verbal communication skills both in person and on the phone
• Familiarity with Microsoft Office and mobile phone and web-based applications

About Monogram Health

Monogram Health is a leading multispecialty provider of in-home, evidence-based care for the most complex of patients who have multiple chronic conditions. Monogram health takes a comprehensive and personalized approach to a person’s health, treating not only a disease, but all of the chronic conditions that are present - such as diabetes, hypertension, chronic kidney disease, heart failure, depression, COPD, and other metabolic disorders.

Monogram Health employs a robust clinical team, leveraging specialists across multiple disciplines including nephrology, cardiology, endocrinology, pulmonology, behavioral health, and palliative care to diagnose and treat health issues; review and prescribe medication; provide guidance, education, and counselling on a patient’s healthcare options; as well as assist with daily needs such as access to food, eating healthy, transportation, financial assistance, and more. Monogram Health is available 24 hours a day, 7 days a week, and on holidays, to support and treat patients in their home.

Monogram Health’s personalized and innovative treatment model is proven to dramatically improve patient outcomes and quality of life while reducing medical costs across the health care continuum.

Equal Opportunity Employer
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