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