RN Nurse Care Manager, In-Home Primary Care

HarmonyCares; Cincinnati (OH); On-site; USD 70,000 - 95,000; Full time

Benefits offered by this job

Quarterly bonuses

Health, dental, vision, life insurance

401K with company match

Tuition & licensure reimbursement

Paid time off & holidays

Job summary

HarmonyCares is seeking a Nurse Care Manager to join our home-based care team in the Cincinnati area. You will manage high-risk patients, coordinate care plans, and educate patients and families by telephone, with a focus on improving health outcomes and reducing hospital admissions.

You will work closely with pod leaders and the care team, leveraging Medicare regulations and population health concepts to tailor care. A valid RN license and multi-state licensing may be required.

Qualifications

• Active Registered Nurse License.
• 2+ years of care management experience in community, health plan or hospital systems.
• Strong clinical skills and proactive thinking.
• Effective communication skills.
• Ability to perform extensive telephone assessment.
• Knowledge of Medicare regulations and home care/hospice standards.
• Experience with small group presentations and teaching/training.
• Excellent interpersonal, written and oral skills.
• Working knowledge of email, Word, Excel, PowerPoint.
• Time management to complete duties and documentation.

Responsibilities

• Coordinate care services with pod leader to ensure comprehensive services across the patient journey.
• Develop and manage personalized care plans, address gaps, and engage with resources.
• Coordinate transition of care to prevent avoidable hospital admissions.
• Facilitate High Risk Huddles and ensure follow-up actions are completed.
• Prioritize patients by severity to ensure critical cases receive attention.
• Review medical records to identify gaps and coordinate services.
• Regularly update patient care plans.
• Conduct thorough nursing assessments via telephone.
• Educate patients/caregivers on disease management and prevention.
• Demonstrate strong clinical and communication skills.
• Document interactions and updates in medical records.
• Serve as liaison between patients, providers, and resources.
• Facilitate status and plan of care communication during transitions.

Skills

Care management

Clinical skills

Communication

Telephone assessment

Medicare regulations

Teaching/training

Interpersonal skills

Time management

Documentation

Computer skills

Education

BSN or related field

Multi-state licensing

Tools

Microsoft Office

Job description

HarmonyCares is seeking a Nurse Care Manager to join our home-based care team in the Cincinnati area. You will manage high-risk patients, coordinate care plans, and educate patients and families by telephone, with a focus on improving health outcomes and reducing hospital admissions.

You will work closely with pod leaders and the care team, leveraging Medicare regulations and population health concepts to tailor care. A valid RN license and multi-state licensing may be required.