Job Description

About Sage Health

We believe all seniors regardless of means deserve concierge primary care & wellness, without the concierge fees. They’ve earned it.

Sage Health builds enriching neighborhood health centers that are easy to access, provide or arrange for all of our patients’ healthcare needs, and partner with Medicare Advantage plans that fully cover primary care. Unlike other physician practices, a Sage Health physician has a patient panel of 400 or less, and we collaborate with the best outcomes-oriented specialists and hospitals in each market. Because we are not a fee-for-service provider and manage patients within a global capitation budget provided by Medicare Advantage plans, our only concern and motivation is to keep our seniors healthy.

Sage Health is a destination for the best risk provider talent in the country who are building the new standard-bearing senior model for the United States.

All applicants are considered for all positions without regard to race, religion, color, sex, gender, sexual orientation, pregnancy, age, national origin, ancestry, physical/mental disability, medical condition, military/veteran status, genetic information, marital status, ethnicity, citizenship or immigration status, or any other protected classification, in accordance with applicable federal, state, and local laws. By completing this application, you are seeking to join a team of hardworking professionals dedicated to consistently delivering outstanding service to our customers and contributing to the financial success of the organization, its clients, and its employees. Equal access to programs, services, and employment is available to all qualified persons. Those applicants requiring an accommodation to complete the application and/or interview process should contact team@sage.health.  

About the role

POSITION SUMMARY  

The Nurse Case Manager (RN) is responsible for implementing and reviewing healthcare plans for patients that are geriatric, recovering from serious injuries, or dealing with chronic illnesses. Nurse Case Managers work both within and outside of a hospital or medical facility. The Nurse Case Manager also collaborates with doctors and other medical professionals to give their assigned patients the comprehensive care that they need. This includes advocating for their patients, coordinating their care, and providing other healthcare services and education.   Demonstrates competency and skills to serve a diverse geriatric population.  

What you'll do

PRIMARY RESPONSIBILITIES:  

• Ensure patient information remains secure and confidential.  

• Maintains a safe, secure, and healthy work environment by following Sage Health policy and procedures, complying with legal regulations.  

• Create and manage the plan of care for patients with chronic or serious conditions such as diabetes, heart disease, chronic heart failure, and cancer etc.  

• Advocate for personalized treatment options that address a patient’s unique care needs.  

• Schedule patients’ hospital post discharge appointment, within 72 hours (3 days) post discharge and follow up to ensure they attended.  

• Communicate about a patient’s health condition with the patient and their family.  

• In collaboration with the patient's primary care physicians offer education and guidance for navigating complex medical decisions.  

• Serve as a liaison between patients and their insurance providers to promote quality, cost-effective care with the best patient outcomes.  

• Verifies daily Sage Health patient hospital census and planned discharges.  

• In collaboration with the Chief Medical Officer or designee, identifies and provides appropriate resources and information to assist patients and their family members related to their diagnosis.  

• Holds regular cadence of meetings, and communications with the following: clinical support staff, physician, and operations leadership.  

• Assist primary care physicians in executing virtual appointments in patients' home.  

• Ensures the overall quality of healthcare for each patient.  

• Ensures patient electronic health records are updated with the most recent medical treatments  

• Assist primary care physicians in executing virtual appointments in patients' home.  

• Maintains a state of readiness for health plan audits, local, state, and federal inspections.  

• Responsible for staying up to date and knowledgeable of all nursing regulations in support of the clinical staff.  

• Perform other duties as assigned  

Qualifications

REQUIRED QUALIFICATIONS:  

• B.S. Degree in Nursing  

• Valid and active Registered Nurse license in the state of employment.  

• Certification in Basic Life Support  

• 2-3 years' experience working in an inpatient, outpatient I.e., Home Health, Hospice, or health plan case management.  

• Strong knowledge of clinical assessment skills and experience with chronic disease management  

• Experienced working in medically underserved/culturally diverse communities  

• Excellent interpersonal, written, and verbal communication skills  

• Must be organized and attentive to detail.  

• Ability to manage competing priorities.  

• Ability to work in a fast-paced environment  

• Resourcefulness in problem solving  

• Able to take and follow through with assigned tasks and accountability.  

• Valid driver's license, car insurance, and access to an automobile  

• Must be able to travel between multiple healthcare facilities I.e., centers, hospitals, skilled nursing facilities, and patient homes.  

• Strong knowledge of clinical assessment skills and experience with chronic disease management  

• Experience working with an electronic health record  

• Must be skilled in web navigation and use of mobile hotspots.  

• Experience with Microsoft Office Word, Outlook, and Excel.  

• Full COVID-19 vaccination (including boosters) an essential requirement of this role. Candidates located in states that mandate COVID-19 booster doses must also comply with those state requirements. Sage Health will adhere to all federal, state, and local regulations as well as all client requirements and will obtain necessary proof of vaccination, and boosters when applicable, prior to employment to ensure compliance  

PREFERRED QUALIFICATIONS:   

• Certification in Case Management I.e., ACM (Accredited Case Manager) or CCM (Case Manager Certification) CCM  

• Managed care experience I.e. Medicare HMO, D-SNP  

• Motivational interviewing  

• Bilingual Spanish and English  

Company Perks:

• Medical, Dental and Vision benefits with generous employer provided contributions to offset per paycheck premium costs.
• 3 different medical plan options to provide flexibly to meet personal needs including: 2 PPO options and a CDHP plan that includes a company provided $500/month HSA contribution.
• Healthcare & Dependent Care Flexible Savings Accounts (FSAs)
• Access to Employee Assistance Program (EAP) for personal support and work-life benefits.
• Employer-paid Life Insurance, Short-term and Long-term Disability benefits. Optional voluntary life insurance is also offered.
• A 401k retirement plan offered through Transamerica for long-term financial security.
• Flexible time off including PTO, 7 paid company holidays and 2 floating holidays.
• Opportunities for career growth and advancement within the company.

Reports To : Director of Nursing

PI3ad0422f28c7-30492-34339618

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