Evergreen Nephrology
Healthcare
CareCoordinator-CKDNavigation
Neural analysis suggests this role is
optimal for Mid candidates.
“Care Coordinator - CKD Navigation at Evergreen Nephrology. Skills: Patient Engagement, Care Coordination, Social Determinants of Health, Resource Navigation. Perform telephonic outreach to enroll patients. Establish connection as primary point of contact”
What You'll Achieve.
improving patient outcomes; improving quality of life; delaying disease progression; shifting care to the home; accelerating kidney transplants; achieving better health outcomes; improve quality and health outcomes
Industry & Context.
resolve issues professionally and creatively
work from a dedicated space lacking ongoing interruptions to protect member PHI / HIPAA information
What They're Looking For.
Must Have
3 years of experience in health care coordination, community health work, or similar healthcare related field, Experience with team-based approach to care, Excellent working knowledge of community resources, Exceptional ability to prioritize and task-switch to meet needs of patients and overall care team, Self-directed and motivated to resolve issues professionally and creatively, communication and teaching skills, Intermediate skills with MS Office Suite of products including Outlook and Teams, ability to work effectively in a primarily remote environment: At minimum, a download speed of 25 Mbps and an upload speed of 10 Mbps is wired to the house internet (Cable, Fiber, or DSL) and hardwired to the internet device is recommended, work from a dedicated space lacking ongoing interruptions to protect member PHI / HIPAA information
What You'll Do.
Perform telephonic outreach to enroll patients
Establish connection as primary point of contact
Develop and implement care plans
Facilitate seamless transitions of care
Update established patient care plans
Conduct thorough patient assessments
Connect members to appropriate resources
Guide members in understanding services
Maintain open lines of communication
Ensure accurate and timely documentation
Provide educational resources and solutions
How You'll Work.
Team & Collaboration
partnering with the interdisciplinary care team; collaborative pathways across care settings; In collaboration with your NCM; Maintain open lines of communication with healthcare teams
Communication Scope
communication and teaching skills
Full Job Description
Who You Are You are devoted, compassionate, and enjoy being on the front lines of healthcare, changing the lives of patients by supporting them and the team by focusing on customers. You’re excited about being part of a team that is building a healthcare delivery model that ensures the highest possible quality of life and best outcomes for those in our care. You believe people living with kidney disease deserve the best person- centered, holistic, comprehensive care and want to influence the healthcare system to drive towards that. You thrive in innovative and evolving environments with high rates of change. Who We Are Evergreen Nephrology partners with nephrologists to transform kidney care through a value-based, person-centered, holistic, and comprehensive approach to kidney care. We believe patients living with kidney disease deserve the best care. We are committed to improving patient outcomes and improving quality of life by delaying disease progression, shifting care to the home, and accelerating kidney transplants. We help nephrologists focus on the right patients at the right time across the full care spectrum. We do this by providing them with the best-in-class interdisciplinary clinical resources, analytical insight and tools, and services to patients. We listen to the needs of our patients, our employees, and our client partners, continually working to push beyond the status quo in which the care system manages patients today. This will be a remote position that will support patients in all time zones. Your Role You are responsible for influencing and ensuring the best clinical care for patients through exceptional patient service and care coordination across disciplines. Leveraging an integrated technology platform, you are complemented by an entire interdisciplinary team including Nurse Practitioners, Nurse Care Managers, Dieticians, Pharmacists, Licensed Clinical Social Workers, Population Health Social Workers and Psychiatrists. You will take the lead
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