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Nest Health · 1 month ago

Nurse Care Manager

United States

Full-time

Remote

Mid Level

3+ years exp

Nest Health is a value-based care provider focused on making healthcare accessible to high-risk families. The Nurse Care Manager plays a crucial role in coordinating care, reducing emergency visits, and empowering families to manage their health effectively.

Child CareMedicalMental HealthWellness

Responsibilities

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

Qualification

Louisiana RN licensePediatric experienceValue-based care experiencePopulation health experienceCare coordination experienceInterdisciplinary team experienceCPR certificationCritical thinkingProblem solvingCommunication

Required

Louisiana RN unincumbered license required, compact license a plus

Three years of clinical practice in a hospital, clinic, or home care with pediatric experience being highly desired

Experience and comfort with being held accountable to meeting metrics designed to ensure appropriate prioritization and management of patient panel

Excellent problem solving and critical thinking skills

Strong communicator amongst both patients, families, and colleagues

Maintains CPR certification – BLS

Ability to lift (or pull) 40 pounds

Prolonged periods sitting at a desk and working on a computer

Some travel for training or education purposes may be required

Capable of managing long hours from time to time

Preferred

BSN preferred

One year of experience in value-based care, population health, or care coordination preferred

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

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