Nurse Care Manager
Nest Health
full-time
Posted on:
Location Type: Remote
Location: Remote • Louisiana • 🇺🇸 United States
Visit company websiteJob Level
Mid-LevelSenior
About the role
- Manage market panels to ensure patients and families are getting the right care at the right time through identification of high-risk patients, admission/discharge/transfer notifications, claims data, and findings from visits with Nest. Aggregate individual family members’ care plans to understand and create a clear plan for the family. Lead interventions and coach Family Advocates on priority interventions.
- Identify social determinants of health and work with interdisciplinary team to support family needs and decrease barriers to care.
- Through various modalities (in-person, virtual, or by phone) and based on the patient’s plan of care, the NCM will provide timely, relevant, and clear education to improve patient/family understanding of their conditions and how manage those conditions to improve health outcomes.
- Act as clinical liaison for payer-based Care Management programs supporting both programmatic and individual patient needs as indicated.
- Ensure accountability and follow up for patient care needs through panel management, case studies, and chart reviews. Support intradisciplinary team members on what they need to execute care plans and best support patients.
- Use data and reporting to identify gaps in care or services and conduct patient outreach to facilitate follow-up care or services.
- Visit, educate, and serve as a resource to providers on patients with chronic and/or high-risk conditions that could benefit from extra services to provide coordination and linkage to general medical service.
- Communicate and coordinate with specialists, mental health and nutrition providers regarding Nest patients as needed to ensure patients are receiving the care they need both inside and out of Nest.
- Follow-up with patients within a reasonable amount of time that the information regarding inpatient discharge and ED visits information is made available to Nest Health.
- Complete chart review and preparation ahead of visits specifically related to hospital utilization, social determinants of health, HEDIS quality gaps, and immunization needs.
- Assist in provider efficiency by pending immunizations due for pediatric patients.
- Provide feedback and insights on Nest’s care model for continual refinement to best support patient care and employee experience.
- Intermittently support field team on field visits to fully understand and appreciate the in-home care patients and families receive.
- Collaborate to engage new patients and support outreach efforts.
- Other duties as assigned.
Requirements
- Required: Louisiana RN unincumbered license required, compact license a plus
- BSN preferred
- Three years of clinical practice in a hospital, clinic, or home care with pediatric experience being highly desired
- One year of experience in value-based care, population health, or care coordination preferred
- Experience and comfort with being held accountable to meeting metrics designed to ensure appropriate prioritization and management of patient panel
- Experience serving underserved populations with complex health needs preferred.
- Experience of working as a member of an interdisciplinary team strongly preferred
- Experience working in a start up a plus but not required.
- Excellent problem solving and critical thinking skills.
- Strong communicator amongst both patients, families, and colleagues
- Maintains CPR certification – BLS
- Please note, this position will involve educating and encouraging vaccination against COVID-19.
Benefits
- Family- centric health support with access to Lyric’s comprehensive services for urgent care, behavioral health, psychology, and psychiatry for you and your entire family, including virtual veterinary care for your pets
- Company supported Parental Leave for both primary/non-primary care givers with options for a tiered return to work, and eligibility to receive additional hours PTO for Prenatal Care and Backup Childcare
- Receive reimbursement for work- related vehicle expenses, including commuting and travel costs, for staff who drive as part of their job responsibilities
- Opportunity to receive up to $3,000/year Tuition Reimbursement to support your educational and professional development by covering a portion of costs relating to fees, course materials, or other related expenses.
- Receive employer sponsored short-term and long-term disability benefits to provide financial support in the event of illness or injury that prevents you from working
- Enrollment in 401 (k) Retirement Plan through Human Interest to help save for your future with flexible contribution options
Applicant Tracking System Keywords
Tip: use these terms in your resume and cover letter to boost ATS matches.
Hard skills
clinical practicecare coordinationpopulation healthvalue-based carepatient panel managementchart reviewdata reportingpatient outreachimmunization managementeducation on health conditions
Soft skills
problem solvingcritical thinkingcommunicationcollaborationcoachingaccountabilityinterdisciplinary teamworksupporting underserved populationsengagementresourcefulness
Certifications
Louisiana RN licenseBSNCPR certificationBLS