RN Care Manager, TCM - Pennsylvania
What We Strive For
Strive Health is built for purpose — to transform a broken kidney care system. We are fundamentally changing the lives of kidney disease patients through early identification, engagement and comprehensive coordinated care. Strive’s model is driven by a high-touch care team that integrates with local providers and spans the entire care journey from chronic kidney disease through end-stage kidney disease, leveraging comparative and predictive data and analytics to identify at-risk patients. Strive Health’s interventions significantly reduce the rate of emergent dialysis crash, cut inpatient utilization and significantly improve patient outcomes and experience. Come join our journey as we create THE destination for top talent in the healthcare community and set a new standard for how kidney care should be done.
Why We’re Worth the Application
- We Strive for excellence and were recognized as one of America’s Best Startup Employers for 2023 by Forbes, Circle of Excellence, American Society of Transplantation, 2023, Best Places to Work – Denver, Comparably.com, 2022, Best Places to Work – Denver, Built in Colorado, 2022
- We derive innovation and ideas from through authentic diversity intentionally building a team that represents the populations we serve in partnership with our Employee Resource Groups:
- Strive Forward - LGBTQ
- Underrepresented Minorities
- Women and Allies
- We care and support our Strivers within and beyond work to feel fully charged and empowered through our generous wellbeing offerings including:
- Flexible time off
- Companywide wellbeing days
- Volunteer time off
- Leave packages including a sabbatical, parental leave and eight weeks paid for living donor
- Professional development
- A dedicated certified financial planner
- Headspace, Carrot Fertility and Gympass for all Strivers
- We like to have fun by celebrating our successes as a team through team building, company gatherings, trivia, wellbeing raffles, pajama days, a companywide book club and more.
- We value tenacity to help us overcome obstacles with grit and determination to deliver compassionate kidney care.
RN Care Manager of Transition
The Registered Nurse (RN) Manager of Transition works alongside Strive care coordinators and nurse practitioners to coordinate and facilitate quality, cost-effective care while minimizing fragmentation of the healthcare delivery system for CKD and ESRD patients. The RN care manager will work specifically on Transition of Care Management efforts, to outreach patients who have been newly discharged from the in-patient setting within specified time requirements. The RN Care Manager will take every care management measure possible to help avoid patient complications and readmissions.
- Identifies newly discharged patients and outreaches within 48 hours
- Assesses for immediate needs and identifies any signs and symptoms of potential complication
- Completes a comprehensive medication reconciliation
- Ensures patient understands all discharge instructions and newly prescribed medications
- Completes a full TCM Care Plan and ensures that it is shared with patient and patient’s entire care team
- Ensures that the patient has necessary follow-up visits scheduled with care team
- Collaborates with the care team to develop and or adjust the individualized and comprehensive care plan for the patient
- Identifies patient and/or clinic staff knowledge and understanding deficits regarding their specific program and situation. Provides the appropriate education, support and materials to facilitate informed decision making and understanding.
- Assesses patient conditions, in conjunction with the care team, such as the discovery of unreported medical and social conditions, or changes at home that may lead to adverse outcomes and ensures these concerns are referred to the appropriate sources for attention.
- Maintains and updates the appropriate program software to manage and record required information and data. Generates and analyzes reports as needed for management, identifying trends, anomalies and areas of concern.
- Adheres to company and clinical guidelines to identify, review, assess and allocate patients for program participation according to their identified needs
- Participates in process improvement activities.
- Collaborates with all levels of the clinical team to improve processes, communication, and team skills needed to provide the best care to our patients
- Utilizes clinical judgment, independent analysis, critical thinking skills, time management skills and detailed knowledge of case management program
- Participates in after hours on call program
- BSN or MSN degree from accredited school of nursing required.
- Current Registered Nurse (RN) license in the state of practice required.
- Minimum of 5 years’ experience in clinical nursing required.
- Current BLS certification
- Internet Connectivity - Min Speeds: 3.8Mbps/3.0Mbps (up/down): Latency <60 ms
- Skilled and passionate caring for patients with complex needs
- Demonstrated knowledge and understanding of data and managing to clinical, financial, and patient satisfaction outcomes.
- Demonstrated experience and effectiveness in change agent role.
- Excels at developing strong patient/family relationships that fosters engagement and best outcomes for all aspects of Strive Health’s Model of Care
- Basic computer skills and proficiency in MS Word and Outlook required
Annual Salary Range: $72,800.00-$96,050.00
Strive Health offers competitive compensation and benefits, including Health insurance, Dental insurance, Vision insurance, 401k Retirement Plan with Employer Match, Life and Accidental Death & Dismemberment insurance, Disability insurance, Health Savings Account, Flexible Spending Account, paid company holidays, in addition to Vacation Time Off. An annual performance bonus, determined by company and individual performance, is available for many roles as aligned to Strive Health guidelines.
Strive Health is an equal opportunity employer and drug free workplace. At this time Strive Health is unable to provide work visa sponsorship. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, disability status, protected veteran status, or any other characteristic protected by law. Please apply even if you feel you do not meet all qualifications. If you require reasonable accommodation in completing this application, interviewing, completing any pre-employment testing, or otherwise participating in the employee selection process, please direct your inquiries to firstname.lastname@example.org