Care Manager, RN

Aledade, Inc.; Greenbelt (MD); Remote; USD 85,000; Full time

Job summary

Aledade, Inc. is seeking a Care Manager, RN to join their team. This remote position involves comprehensive patient assessments and care coordination while working with primary care practices in Maryland. Ideal candidates will have a solid background in healthcare, a current RN license, and strong communication skills.

Qualifications

• Current RN license in Maryland required.
• 3-5 years of direct healthcare experience, preferably in home health or care coordination.

Responsibilities

• Conduct comprehensive assessments for patient care.
• Coordinate care and facilitate communication among care teams.
• Support patients in self-management and access to healthcare services.

Skills

Communication

Patient Advocacy

Care Coordination

Self-Management Support

Problem-Solving

Education

Registered Nurse in Maryland

Job description

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The Care Manager will work with Aledade primary care practices in Maryland as a part of the Maryland Primary Care Program. The care manager collaborates with the care team within each practice and leverages Aledade’s interdisciplinary care team to provide telephone-based health coaching, quality improvement, and care coordination. The care manager works closely with Medicare patients to support them in becoming active in their health care by better understanding their chronic conditions, helping them access care in the most appropriate setting, and improving quality of care. Care managers utilize Aledade’s proprietary population health tool, the “Aledade App” to manage high-risk patients, using real-time data to identify and intervene on high utilizers who could benefit from more preventative and active management.

This position is remote but will require travel to your assigned practices once a month and you will travel periodically to work related team retreats and events.

Primary Duties:

• Conduct comprehensive assessments that include the medical, behavioral, pharmaceutical and social needs of the patient, identify and address gaps in care and barriers to attaining improved health; Assess the patient’s knowledge of their clinical condition;
• Provide education and self-management support based on the patient’s unique learning style; Work with the patient and their caregiver to increase their self-efficacy and ability to play a central role in their care; Coordinate care by serving as the advocate and resource for the patient, their family, and their physician, building effective relationships in the community and across the continuum of care; provide patients with care transition planning support and follow up;
• Collaborate with the patient’s primary care physician and care team if applicable, to identify high-risk patients and design appropriate care plan interventions; participate in and help facilitate periodic complex care rounds with interdisciplinary care team;
• Provide clinical oversight to non-licensed support staff (e.g. health coaches, patient navigators, community health specialists, etc.) and delegate supportive tasks as appropriate;
• Support implementation of Aledade initiatives that support population health care management (vendors for end of life care, virtual behavioral health, etc.). Measure, improve and maintain quality outcomes (clinical, financial, and functional) for individual patients and the population served; understand the requirements and intent of the Maryland Primary Care Program, and develop and execute care plans focused on reducing unnecessary hospital and specialist utilization and improving quality.
  
  

Required Qualifications:

• Current Registered Nurse in Maryland
• 3-5 years of direct healthcare experience, preferably in home health, ambulatory care, community public health, case management, or care coordination across multiple settings with multiple providers
  
  

Preferred Key Skills and Abilities:

• Familiarity with the healthcare community we are serving or commitment to learn and understand through on the ground networking, community assessment, etc.
• Population health and/or managed care experience
• Understanding of quality metrics
• Knowledge and experience activating patients and teaching self-management skills
• Experience working with vulnerable populations (geriatrics, minorities, behavioral health)
• Ability to navigate ambiguity with the aid of structured problem-solving techniques
• Exceptional communication skills, both written and oral, ability to positively influence others with respect and compassion
• Strong work ethic built on a foundation of proactivity, collaboration, and teamwork
• Committed to the practice of inquiry and listening
• Competent documenting in electronic health records
• Demonstrates curiosity of learning and receiving critical feedback to further growth and development
  
  

Physical Requirements:

• Sedentary work on telephone and computer with repetitive movements
• Finger dexterity
• Proficient communicative, auditory, and visual skills
• Ability to travel to practices if needed and travel to work related team retreats
  
  

$85,000 - $85,000 a year

Salary is $85,000 base + bonuses + equity

Compensation for the role will depend on a number of factors, including a candidate’s qualifications, skills, competencies and experience.

Seniority level

• Seniority level

  Mid-Senior level

Employment type

• Employment type

  Full-time

Job function

• Job function

  Health Care Provider

• Industries

  Hospitals and Health Care

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