Nurse Care Manager

About the Company

Evergreen Nephrology partners with nephrologists to transform kidney care through a value-based, person-centered, holistic, and comprehensive approach. We are committed to improving patient outcomes and quality of life by delaying disease progression, shifting care to the home, and accelerating kidney transplants.

Responsibilities

  • Manage overall care management of patient caseload using nursing expertise and value-based care knowledge
  • Facilitate seamless transitions for nephrology patients from Skilled Nursing Facilities to home or community
  • Collaborate with hospital discharge planners, providers, and SNF staff to address patient needs
  • Monitor patient progress in SNFs and identify barriers to timely discharge
  • Participate in clinical huddles, IDT meetings, and patient care conferences
  • Develop strategies to optimize length of stay while maintaining high-quality care
  • Perform assessments to identify social determinants of health and translate them into actionable care plans
  • Establish trusting relationships with patients and families to provide clinical and emotional support
  • Collect data to report on program success, patient outcomes, and satisfaction

Requirements

  • BSN with active RN license or Bachelor's/Master's in Physical Therapy with active PT license (required in Illinois)
  • 3-5 years of experience in telephonic care management and post-acute care
  • Active license in good standing in the state of Illinois
  • Experience in Utilization Management and/or Utilization Review
  • Experience in specialty care including kidney care or related field
  • Knowledge of value-based care models and strategies to reduce readmissions
  • Proficiency with MS Office Suite (Outlook, Teams)
  • Ability to work 8:30am – 5pm in Central or Eastern time zone

Benefits

  • Paid time off starting at 4 weeks
  • 12 paid holidays per year
  • Medical, dental, vision, and life insurance
  • HSA with employer match
  • Reimbursement for continuing medical education
  • 401(k) with up to 4% employer match
  • Paid parental leave
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