Bilingual Care Manager - Registered Nurse

Monogram Health•Sierra Vista, AZ

About The Position

Monogram Health is seeking a skilled bilingual Registered Nurse to serve as a Care Manager on an integrated team that includes an Advanced Practice Provider and a Social Worker. The role supports patients with multiple serious and chronic conditions, helping them improve their quality of life at home and slow the progression of kidney disease. The Care Manager works with a small panel of patients and builds trusting relationships through personalized care and education. The position involves coordinating with patients’ medical providers, conducting in-home care management visits, monitoring biometric data, supporting medication adherence, and helping patients navigate care transitions. The nurse serves as a primary contact for patients during business hours and provides education and coaching on health conditions, medications, diet, exercise, lifestyle choices, and care decisions. The base salary range is $80,072 to $96,836. Final compensation depends on geographic location and job-related factors, and the role is eligible for bonus opportunities and a comprehensive benefits package. Frequent local travel is required for in-home visits, with infrequent domestic travel potentially required, primarily to Brentwood, Tennessee, for training. The nurse may also need to take remote call on some nights and weekends.

Requirements

Bilingual in English and Spanish.
Graduate of an accredited School of Nursing.
Currently licensed as a Registered Nurse in the state of the posted location.
At least 2 years of previous experience working in care management and/or with CKD/ESRD patients.
BLS for Healthcare Providers certification.
Ability to take remote call on some nights and weekends.
Ability to work independently with minimal supervision.
Empathy and ability to build relationships quickly with patients and physicians.
Excellent verbal communication skills in person and by phone.
Familiarity with Microsoft Office and mobile phone and web-based applications.
Ability to travel locally frequently for in-home visits.

Responsibilities

Work with patients’ medical providers to develop and continually adapt care plans.
Perform in-home care management visits to carry out care plans.
Monitor biometric data and follow approved protocols for necessary interventions.
Inventory and reconcile medications and coordinate with pharmacists and prescribers.
Conduct patient health assessments and surveys as required.
Provide individual and group education on CKD, ESRD, dialysis, and related comorbidities.
Encourage medication and treatment adherence through frequent patient contact.
Engage patients’ families and social support groups in patient education and care.
Serve as the primary point of contact and first call for patient questions during business hours.
Educate and coach patients on medications, medical conditions, diet, exercise, and lifestyle choices.
Educate patients and facilitate conversations about proactive care decisions, including advance care plans and ESRD treatment options.
Obtain vital signs during patient visits and escalate concerns to the provider.
Initiate patient relationships through enrollment and onboarding.
Perform post-operative and hospital discharge visits to support patients through vulnerable transitions.
Review and document patient updates and progress in the care management platform.
Coordinate with dialysis providers to support seamless transitions of care.