RN Case Manager, TCM

What You’ll Do 

Strive’s RN Care Managers are a critical part of supporting patient care for individuals with Chronic Kidney Disease (CKD) and End-Stage Renal Disease (ESRD). Serving as a vital resource for patients, families, local care teams, and healthcare professionals, the RN Care Manager coordinates services to optimize care delivery. While primarily conducted via telecommunication, this role may necessitate on-site visits to various healthcare settings or patient homes. This hybrid role includes in-home visits based on patient requirements, with potential face-to-face meetings with colleagues and leadership as needed. This role will report to the Lead, RN Care Manager. 

The Day to Day 

• Works closely with the care team to craft personalized and thorough care plans addressing the clinical and non-clinical needs of each patient. 
• Conducts regular assessments onsite and virtually to detect undisclosed medical or social issues and changes in the home environment that could pose risks, promptly referring such matters to the appropriate channels for resolution. 
• Initiates proactive outreach to patients and/or clinics as outlined in program guidelines to evaluate their status, offer assistance, and address inquiries promptly. 
• Manages a diverse patient panel, swiftly and accurately evaluating individual needs while adhering to NCQA standards for complex case management. 
• Communicates updates to the care team and family members, identifying gaps in patient understanding of their health status and delivering tailored education and resources to promote informed decision-making. 
• Acts as a liaison with dialysis facilities, conveying care plan updates to facilitate smooth transitions in care, and maintains accurate program software records. 
• Leverages Strive data platforms to identify trends, anomalies, and areas requiring focus.
• Provides culturally sensitive care to meet the diverse needs of Strive patients, fostering collaboration and communication among all clinical team members to enhance care provision. 
• Utilizes clinical judgment, analytical skills, regular and predictable attendance, and comprehensive knowledge of case management programs to deliver high-quality care. 

Minimum Qualifications 

• Associate’s degree from accredited school of nursing. 
• Current Registered Nurse (RN) license in the state of California
• 3 years combined of related education, experience, or certification. 
• Current BLS or CPR Certification required.   
• Efficient and reliable transportation allowing for the ability to commute to patient’s homes. 
• Provides in-person patient care which may include standing, sitting, walking, pushing, pulling, and lifting. 
• Internet Connectivity - Min Speeds: 3.8Mbps/3.0Mbps (up/down): Latency <60 ms.  

Preferred Qualifications 

• 3 years experience in nephrology, ER, ICU, Cardiac, or Ambulatory Complex case management nursing.  
• Certified Case Manager (CCM) certification preferred. 
• Proficiency in computer skills including Microsoft 365 Suite (word, outlook, excel) due to working in a hybrid-remote environment. 

About You

• Experience developing strong patient and family relationships that foster engagement and best outcomes for all aspects of Strive Health’s Model of Care.  
• Demonstrated experience with proactively contacting patients and/or clinic on a frequent basis to assess both clinical and non-clinical needs. 
• Proficiency with documenting and navigating electronic medical records (EMR) and care plan management. 

Annual Salary Range: $74,000.00-$90,000.00

Salary : $74,000 - $90,000