Nurse Care Manager, Praxis Health

Remote opportunity for residents of Oregon, Washington, and Idaho. The Nurse Care Manager supports patients through every stage of their healthcare journey by coordinating care, ensuring timely follow-up, and promoting evidence-based practices. This role bridges communication between patients, families, and providers to improve outcomes, reduce avoidable hospitalizations, and enhance patient satisfaction across Praxis Health clinics. Compensation: $30-$37/hour, depending on experience Schedule: Full-time; Monday-Friday, 8-hour shifts, or four 9-hour shifts per week Essential Duties and Responsibilities The following essential job functions are intended to describe the general nature and level of work performed. They are not intended to be an exhaustive list of all responsibilities, duties, and skills required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. Serve as a patient advocate and navigator, guiding patients and caregivers through the healthcare system. Review provider notes, discharge summaries, and clinical documentation to provide personalized patient education based on condition-specific knowledge and best practices. Complete emergency room and hospital follow-up calls, offering education on alternative access points (e.g., urgent care, same-day appointments, telehealth) to reduce avoidable ED visits. Perform comprehensive medication and allergy reconciliation with patients, caregivers, or facilities; verifying names, dosages, and frequencies per clinical protocols. Facilitate medication education and adherence support, including alignment with standing orders, protocols, and chronic disease management goals. Identify and support high-risk patients, including those with chronic conditions, frequent hospitalizations, or complex care needs, through proactive care coordination and outreach. Communicate clinical updates to Primary Care Providers (PCPs), ensuring timely follow-up appointments within the appropriate care windows. Coordinate continuity of care across settings (e.g., inpatient, outpatient, specialty, post-acute), including referrals and collaboration with external providers and facilities. Collaborate with interdisciplinary care teams, including primary care, chronic care management, and the Quality department, to identify barriers to care and improve care delivery. Actively participate in system-wide quality and population health initiatives, including but not limited to: Medication adherence programs Statin use monitoring High-cost care management Emergency department utilization reduction Advance care planning Reduction in readmission Monitor daily reports and EHR-based alerts to identify patients in need of outreach or follow-up based on clinical risk or recent utilization. Maintain timely, complete, and compliant documentation of all patient interactions, care coordination activities, lab orders, charges, and communications within the EHR. Coordinate patient documentation needs, including requesting and organizing medical records in compliance with organizational and regulatory standards. Promote effective communication across care teams, ensuring awareness of care plans, follow-up needs, and changes in clinical status. Evaluate care delivery processes and contribute to the development and refinement of workflows, tools, and procedures to support quality and efficiency. Participate in internal and external improvement initiatives, collaborative partnerships, and payor-aligned programs focused on patient outcomes and system performance. Support onboarding and mentoring of clinical team members as appropriate to experience and licensure. Complete assigned EHR tasks and responsibilities accurately and on time, as delegated by leadership. Maintain compliance with state licensure requirements and practice within the legal scope of an RN or LPN, as applicable. Stay current with required continuing education, certifications, and competencies. Adhere to all HIPAA, privacy, and security standards, as well as organizational policies. Demonstrates a consistently professional, respectful, and constructive attitude in all interactions. Fosters a positive, team-oriented work environment by building trust, encouraging collaboration, and communicating effectively with team members, clients, and leadership. Maintain professionalism, adaptability, and respect in all interactions to support a positive, team-oriented work environment. Demonstrates professionalism, reliability, and teamwork in all interactions. Actively contributes to a culture of respect, accountability, and collaboration. Perform other duties as assigned, which may include additional responsibilities that are essential to the operation of the department or company. This job description is intended to outline the primary duties and qualifications of the role but is not all-inclusive. Essential functions may evolve or emerge over time in response to operational needs, regulatory requirements, or company changes. Qualifications Education Required: Associate Degree in Nursing (ADN), or Bachelor of Science in Nursing (BSN). Strongly Preferred: Additional coursework in care coordination or population health preferred. Experience Required: At least three years of clinical experience in ambulatory care, care coordination, transitional care, or discharge planning (preferred). Proficient in EHR documentation and experience in multidisciplinary team collaboration. Experience collaborating with multidisciplinary care teams. Preferred: Experience working with high-risk patient populations, acute care, chronic disease management, or value-based care models. Prior involvement in quality improvement initiatives, population health programs, or patient navigation. Licensure/Certification Required: Current RN license (Oregon, Washington and/or Idaho) in good standing in state of practice; willingness to obtain additional licensure in Praxis states as needed. Valid driver's license and reliable transportation if travel between sites is required. Preferred: Certification in Care Coordination, Case Management, or related fields (e.g., CCM, CCTM, CHW). Current Basic Life Support (BLS) certification. Knowledge, Skills, and Abilities Knowledge of medical terminology, vital sign #J-18808-Ljbffr Praxis Health