Nursing Jobs in Selma, CA
$100,000 - $120,000 / year
Job Description: Care Manager – Registered Nurse Monogram Health is looking for skilled Registered Nurse eager for the opportunity to make a difference in patients' lives. The Care Manager RN is a key member of an integrated Care Team which includes an Advanced Practice Provider and a Social Worker. The patients we serve often struggle with multiple serious diseases. Registered Nurses help patients improve their quality of life in the home and slow the progression of kidney disease, enabling positive health outcomes. Your Impact: As a Registered Nurse, you are an integral part of building trusting relationships with patients, so that they can experience a high quality of life at home. Work with a small panel of patients where you can directly experience the impact of your care. In healthcare systems, the patient has too often become secondary due to processes and incentives that don’t positively impact the patient for the long term. Here at Monogram, we strive to change that narrative by putting our patients and their quality of life at the forefront of what we do. Highlights & Benefits Competitive compensation and a performance-based bonus program Full benefits package including medical, dental, vision, life insurance, 401(k) plan with matching contributions, paid vacation and holiday time 20 PTO days, 7 paid holidays, and 1 floating day to make your own. The base salary range for this role is $100,000 to $120,000 and reflects the range of experience and qualifications we may consider. Final compensation will be determined based on geographic location and job-related factors such as experience, skills, education, certifications, and internal compensation considerations. While a larger range is posted, most offers will typically fall within a narrower band based on these factors. In addition to base salary, this role is eligible for additional compensation, including bonus opportunities and a comprehensive benefits package. Responsibilities Work closely with patients’ medical providers to develop and continually adapt care plan Perform in-home care management visits to execute care management plan Monitor biometric data and follow approved protocols for any necessary interventions Inventory and reconcile medications and coordinate with pharmacists and prescribers Perform patient health assessments and surveys as required Deliver individual and group education on CKD, ESRD, dialysis and associated comorbidities Encourage medication and treatment adherence through frequent contact with patients Engage family and social support groups in the education and care of patients Serve as the primary point of contact and be the first call when patients have questions (business hours) Provide education and coaching around medications, medical conditions, diet, exercise, and lifestyle choices Educate patients and facilitate conversations around proactive care decisions, especially relating to Advance Care Plans and ESRD treatment modalities Obtain vital signs when visiting patient and escalate any concerns to the provider Initiate patient relationships through enrolment and onboarding processes Perform post-op and hospital discharge visits to help patients through vulnerable transitions Review and document patient updates and progress in care management platform Coordinate with dialysis providers to ensure transitions of care are seamless Position Requirements Frequent local travel to perform in-home visits Basic Life Support (BLS) certification is required in this role. The company will support your certification completion through onboarding Infrequent domestic travel may be required, primarily to Brentwood, TN for training Self-starter with the ability to work independently with minimal supervision Ability to show empathy and quickly build relationships with patients and physicians Graduate of an accredited School of Nursing Currently licensed as a Registered Nurse in the State of the posted location 2+ years previous experience working in care management and/or with CKD/ESRD patients Ability to take call remotely on some nights and weekends Excellent verbal communication skills both in person and on the phone Familiarity with Microsoft Office and mobile phone and web-based applications About Monogram Health Monogram Health is a leading multispecialty provider of in-home, evidence-based care for the most complex of patients who have multiple chronic conditions. Monogram health takes a comprehensive and personalized approach to a person’s health, treating not only a disease, but all of the chronic conditions that are present - such as diabetes, hypertension, chronic kidney disease, heart failure, depression, COPD, and other metabolic disorders. Monogram Health employs a robust clinical team, leveraging specialists across multiple disciplines including nephrology, cardiology, endocrinology, pulmonology, behavioral health, and palliative care to diagnose and treat health issues; review and prescribe medication; provide guidance, education, and counselling on a patient’s healthcare options; as well as assist with daily needs such as access to food, eating healthy, transportation, financial assistance, and more. Monogram Health is available 24 hours a day, 7 days a week, and on holidays, to support and treat patients in their home. Monogram Health’s personalized and innovative treatment model is proven to dramatically improve patient outcomes and quality of life while reducing medical costs across the health care continuum. #LI-AW1 $91,249.60 - $120,910.40 / year
Overview: What you can expect! Find joy in serving others with IEHP! We welcome you to join us in “healing and inspiring the human spirit” and to pivot from a “job” opportunity to an authentic experience! Reporting to Health Access Enhanced Care Management Department Leadership, this position is responsible for working effectively with the Health Access Enhanced Care Management (ECM) Care Coordination team, members and families, other professionals, and the designated healthcare care organization (HCO) medical team to provide high quality, effective care management to IEHP members. This position focuses on a person-centered model of care which takes in to account the member’s medical, behavioral, and social needs. This position provides high quality, effective care management to IEHP members ensuring coordinated continuous care. Care Management is broadly defined, and can include outreach and engagement to members, engaging members in skilled therapeutic interactions to promote health behaviors, other behavioral health interventions within scope, coordination of care, resource linkages, working with other professionals, and organizations in the community to ensure quality of care for members, seamless transitions of care, and facilitating the right care and the right time for the member. As a licensed clinician, this position provides clinical expertise, clinical leadership, and clinical oversight in a variety of ways within the Enhanced Care Management program. This position, like all positions within the HA ECM team, is expected to model behavioral health principles of relationship-based care, as well engage in promoting education and understanding of behavioral health and its importance in whole health, to those within IEHP and in the community. This is a field-based position in which Care Team Members will meet with our highest risk/high utilizer population face to face, per member's consent. The individual in this position is to utilize their clinical expertise to support and engage members to promote positive health behaviors, assist with coordination of care, provided resource linkages, and collaborate with other Team Members within their care team, as well as external partners, to ensure a seamless transition of care experience. Commitment to Quality: The IEHP Team is committed to incorporate IEHP’s Quality Program goals including, but not limited to, HEDIS, CAHPS, and NCQA Accreditation. Additional Benefits: Perks IEHP is not only committed to healing and inspiring the human spirit of our Members, but we also aim to match our team members with the same energy by providing prime benefits and more Competitive salary State of the art fitness center on-site Medical Insurance with Dental and Vision Life, short-term, and long-term disability options Career advancement opportunities and professional development Wellness programs that promote a healthy work-life balance Flexible Spending Account – Health Care/Childcare CalPERS retirement 457(b) option with a contribution match Paid life insurance for employees Pet care insurance Key Responsibilities: Exercise independent clinical judgment and strategic planning in managing a caseload of members with medical needs according to department processes and procedures. Recommend care coordination strategies for members, including but not limited to: Utilize clinical tools and metrics (i.e., brief medical interventions) as necessary to inform interventions, manage caseloads, and escalate high-risk cases appropriately. Engage with members, both in-person and on the phone, in a manner that utilizes evidence-based approaches (such as Motivational Interviewing) that promotes collaboration between the member and his or her medical/behavioral team, as well as improving the member’s ability to manage and control their whole health. Conduct comprehensive, holistic assessment according to the scope of the RN license. Assimilate assessment information into an individualized care plan (ICP), communicate ICP with members, approved family or caregiver, and other members of the care team. Lead inter/transdisciplinary care team meetings to share information, update and inform care plan Coordinate with internal and external health partners to support Members comprehensive care needs Participate and lead care transition plan responsibilities Assist with the coordination of medical and behavioral health access issues with PCP offices, specialists, and ancillary services Coordinate care for members with complex medical and social needs, including across the physical, behavioral, and dental health delivery systems Provide formal and informal training and support for Health Access Team Members on medical conditions, including treatments and evidence-based for treatment. Provide clinical consultation and support for Health Access ECM Team Members on physical health conditions, including evidence-based care Represent the Enhanced Care Management team as the lead member when necessary Develop interventions to improve the member’s ability to manage their own health Support the clinical scope of responsibilities for non-clinically licensed care Team Members within the RN scope of practice Cultivate and sustain productive partnerships with providers, team members, and community stakeholders. Employ advanced communication methods to strengthen collaboration across in-person, telephonic, and digital platforms. Model supportive and collaborative relationships with Members, co-workers, and community relations Promote a collaborative and effective working environment within the Health Access Enhanced Care Management team by engaging in evidenced-based communication strategies (such as Motivational Interviewing) when discussing responsibility/sharing of tasks, effectively resolving conflicts as arise, and collaborating on Member case discussions Model the highest ethical behavior in relationships with co-workers, supervisors, Members, Providers, and colleagues in the community Model commitment to continuous quality improvement by engaging in quality improvement initiatives and projects, such as identifying and addressing performance indicator measures, HEDIS gaps, and other quality measures Participate in staff meetings, trainings, committee meetings, or other activities as needed or as directed by Leadership Ensure documentation is accurate and in compliance with regulatory requirements and accreditation standards Perform any other duties as required to ensure Health Plan operations and department business needs are successful Qualifications: Education & Requirements Three (3) or more years of care management experience in a health care delivery setting required. Experience working successfully within a team, and experience in developing and maintaining effective relationships with both clients and coworkers is mandatory Experience in a Managed Care setting preferred Minimum of one (1) year clinical experience in an acute care facility, skilled nursing facility, home health or clinic setting preferred Population of Focus Experience: Adults, unaccompanied youth & children, and families experiencing homelessness Adults, youth, and children who are at risk for avoidable hospital or ED care Adults, youth, and children with serious mental health and/or substance use disorder needs Adults living in the community and at risk for long-term care institutionalization Adult nursing facility residents transitioning to the community Children & youth enrolled in CCS or CCS Whole Child Model with additional needs beyond their CCS conditions Children & youth involved in child welfare (foster care) Adults & youth who are transitioning from incarceration Pregnant & postpartum individuals; birth equity population of focus Associate’s degree in Nursing from an accredited institution required Bachelor’s degree in Nursing from an accredited institution preferred Possession of an active, unrestricted, and unencumbered Registered Nurse (RN) license issued by the California BRN required Certified Case Manager (CCM) preferred Key Qualifications Must have a valid California Driver’s license and valid automobile insurance. Must qualify and maintain driving record to drive company vehicles based on IEHP insurance standards of no more than three (3) points Strong knowledge and in-depth understanding of: Skill in evidenced based communication such as Motivational Interviewing, or similar empathy-based communication strategies Understanding of and sensitivity to multi-cultural community Self-management philosophies and practices, especially as they relate to chronic medical conditions Awareness of the impact of unmitigated bias and judgement on health; commitment to addressing both Bilingual (English/ “Target Language”) preferred Highly skilled interpersonally, with excellent relationship skills Highly skilled in interpersonal communication, including resolving conflict with co-workers Skillful in informally and formally sharing expertise Must have skills to tolerate, manage and make effective use of a high level of ambiguity around new team models, new models of care, and new care management practices Start your journey towards a thriving future with IEHP and apply TODAY ! Work Model Location: Telecommute (All IEHP positions approved for telecommute work locations may periodically be required to report to IEHP’s main campus for mandatory in-person meetings or for other business needs as determined by IEHP leadership) Significant travel outside of the office to Providers offices, member’s homes, and out to the community. Must live within a 25-mile radius of the assigned service area and have reliable transport Pay Range: USD $91,249.60 - USD $120,910.40 /Yr. 
