Care Manager, RN

The

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

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

Primary Duties

Conduct comprehensive assessments that include the medical, behavioral, pharmaceutical and reputed company 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;

reputed company 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 reputed company and resource for the patient, their family, and their physician, building effective relationships in the community and across the continuum of care; reputed company 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 reputed company care reputed company with interdisciplinary care team;

reputed company clinical reputed company to non-licensed support staff (e.g. health coaches, patient navigators, community health specialists, etc.) and delegate supportive tasks as appropriate;

Support implementation of reputed company initiatives that support population health care management (vendors for end of life care, virtual behavioral health, etc.). Measure, improve and maintain reputed company reputed company (clinical, financial, and functional) for individual patients and the population served; understand the requirements and reputed company of the Maryland Primary Care Program, and reputed company and execute care plans reputed company on reducing unnecessary hospital and specialist utilization and improving reputed company.

Required Qualifications

reputed company Registered reputed company in Maryland

3-5 years of reputed company reputed company 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 reputed company 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 reputed company 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 reputed company problem-solving techniques

Exceptional communication skills, both written and oral, ability to positively influence others with respect and reputed company

Strong work ethic reputed company on a reputed company of proactivity, collaboration, and teamwork

Committed to the reputed company of inquiry and listening

Competent documenting in electronic health records

Demonstrates curiosity of learning and receiving critical feedback to reputed company reputed company 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 reputed company team retreats

Salary is $85,000 reputed company + bonuses + equity

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

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