Bilingual Care Manager - Registered Nurse

Monogram Health•Sierra Vista, AZ

4d•$80,072 - $96,836

About The Position

Monogram Health is seeking a bilingual Registered Nurse to serve as a Care Manager on an integrated Care Team that includes an Advanced Practice Provider and a Social Worker. The role supports patients with multiple serious and chronic diseases, 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 while keeping patients’ needs and quality of life at the center of care. The position includes in-home care management, coordination with providers and other care partners, patient assessment and education, monitoring of biometric data, and support through hospital and post-operative transitions. The nurse serves as patients’ primary point of contact during business hours and provides coaching and education to support informed care decisions and treatment adherence. Frequent local travel is required for in-home visits; infrequent domestic travel may be required, primarily to Brentwood, Tennessee, for training. The role may also involve taking remote call on some nights and weekends. 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.

Requirements

Must be bilingual in English and Spanish.
Must hold BLS for Healthcare Providers certification.
Must be a graduate of an accredited School of Nursing.
Must hold a current Registered Nurse license in the state of the posted location.
At least 2 years of previous experience in care management and/or working with CKD/ESRD patients.
Ability to work independently with minimal supervision.
Ability to demonstrate empathy and 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 take remote call on some nights and weekends.
Frequent local travel for in-home visits; infrequent domestic travel may be required, primarily to Brentwood, Tennessee, for training.

Responsibilities

Work with patients’ medical providers to develop and continually adapt care plans.
Conduct 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 for patients during business hours.
Coach and educate patients about medications, medical conditions, diet, exercise, and lifestyle choices.
Educate patients and facilitate conversations about proactive care decisions, including Advance Care Plans and ESRD treatment modalities.
Obtain vital signs during patient visits and escalate concerns to the provider.
Initiate patient relationships through enrollment and onboarding.
Conduct post-operative and hospital-discharge visits to support patients during vulnerable transitions.
Review and document patient updates and progress in the care management platform.
Coordinate with dialysis providers to ensure seamless transitions of care.