Nurse Care Manager, Praxis Health

Join Our Team as a Nurse Care Manager!

**Remote Opportunity for Oregon Residents Only**

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; 4 days per week, 9-hour shifts; 5 days per week: 4 8-hour shifts and one 4-hour shift

We are excited to share with you a short video that shows why the Praxis Health family is so special. Please click here: https://youtu.be/MrNWtn42prY

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.

1. Serve as a patient advocate and navigator, guiding patients and caregivers through the healthcare system.
2. Review provider notes, discharge summaries, and clinical documentation to provide personalized patient education based on condition-specific knowledge and best practices.
3. 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.
4. Perform comprehensive medication and allergy reconciliation with patients, caregivers, or facilities; verifying names, dosages, and frequencies per clinical protocols.
5. Facilitate medication education and adherence support, including alignment with standing orders, protocols, and chronic disease management goals.
6. Identify and support high-risk patients, including those with chronic conditions, frequent hospitalizations, or complex care needs, through proactive care coordination and outreach.
7. Communicate clinical updates to Primary Care Providers (PCPs), ensuring timely follow-up appointments within the appropriate care windows.
8. Coordinate continuity of care across settings (e.g., inpatient, outpatient, specialty, post-acute), including referrals and collaboration with external providers and facilities.
9. Collaborate with interdisciplinary care teams, including primary care, chronic care management, and the Quality department, to identify barriers to care and improve care delivery.
10. Actively participate in system-wide quality and population health initiatives, including but not limited to:
    1. Medication adherence programs
    2. Statin use monitoring
    3. High-cost care management
    4. Emergency department utilization reduction
    5. Advance care planning
    6. Reduction in readmission
11. Monitor daily reports and EHR-based alerts to identify patients in need of outreach or follow-up based on clinical risk or recent utilization.
12. Maintain timely, complete, and compliant documentation of all patient interactions, care coordination activities, lab orders, charges, and communications within the EHR.
13. Coordinate patient documentation needs, including requesting and organizing medical records in compliance with organizational and regulatory standards.
14. Promote effective communication across care teams, ensuring awareness of care plans, follow-up needs, and changes in clinical status.
15. Evaluate care delivery processes and contribute to the development and refinement of workflows, tools, and procedures to support quality and efficiency.
16. Participate in internal and external improvement initiatives, collaborative partnerships, and payor-aligned programs focused on patient outcomes and system performance.
17. Support onboarding and mentoring of clinical team members as appropriate to experience and licensure.
18. Complete assigned EHR tasks and responsibilities accurately and on time, as delegated by leadership.
19. Maintain compliance with state licensure requirements and practice within the legal scope of an RN or LPN, as applicable.
20. Stay current with required continuing education, certifications, and competencies.
21. Adhere to all HIPAA, privacy, and security standards, as well as organizational policies.
22. 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.
23. Maintain professionalism, adaptability, and respect in all interactions to support a positive, team-oriented work environment.
24. Demonstrates professionalism, reliability, and teamwork in all interactions. Actively contributes to a culture of respect, accountability, and collaboration.
25. 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

1. Required:
   1. LPN certificate/diploma, Associate Degree in Nursing (ADN), or Bachelor of Science in Nursing (BSN).
2. Strongly Preferred:
   1. Additional coursework in care coordination or population health preferred

Experience

1. Required:
   1. At least three years of clinical experience in ambulatory care, care coordination, transitional care, or discharge planning preferred.
   2. Proficient in EHR documentation and experience in multidisciplinary team collaboration.
   3. Experience collaborating with multidisciplinary care teams
2. Preferred:
   1. Experience working with high-risk patient populations, acute care, chronic disease management, or value-based care models
   2. Prior involvement in quality improvement initiatives, population health programs, or patient navigation

Licensure/Certification

1. Required:
   1. Current LPN or RN license in good standing in state of practice; willingness to obtain additional licensure in Praxis states as needed.
   2. Valid driver's license and reliable transportation if travel between sites is required.
2. Preferred:
   1. Certification in Care Coordination, Case Management, or related fields (e.g., CCM, CCTM, CHW).
   2. Current Basic Life Support (BLS) certification.

Knowledge, Skills, and Abilities

1. Knowledge of medical terminology, vital sign collection, and basic clinical procedures.
2. Proficiency in using EHR systems and Microsoft Office 365 applications (including SharePoint).
3. Ability to multitask, prioritize, and maintain attention to detail.
4. Strong interpersonal and communication skills.
5. Ability to work independently and as part of a team.
6. Commitment to maintaining patient confidentiality and professionalism at all times.

Work Environment and Physical Requirements

1. Remain seated in a stationary position for prolonged periods of time.
2. Requires frequent computer use and ability to remain seated for extended periods. Must be able to communicate clearly and occasionally lift up to 20 pounds.
3. Visual acuity for computer work, working full shift on multiple computer monitors.
4. Regularly talk and listen to staff and patient/caregivers.
5. Reach with hands or arms.
6. No heavy lifting is expected, although occasional lifting of up to 20 lbs. (example: lifting a computer/laptop/monitor) may be required.
   
   

About Our Company

Praxis Health is a family of medical groups providing high-quality healthcare throughout the state of Oregon. Our community-based clinics are the DNA of our business, providing better medicine, advocacy for our patients, and a satisfying and collaborative culture for our providers and staff. The Praxis family approach is dynamically different from other healthcare companies in Oregon. We are not "big box" health care, but rather a company of small groups and clinics, of nimble micro-cultures that can quickly adapt to industry changes, as well as patient needs. We have been serving communities across the beautiful and adventurous state of Oregon for over 50 years! And we are pioneers and thought leaders in the industry. Our commitment to innovative and operational excellence has allowed us to create healthcare solutions that are both cost-efficient and cutting-edge. Come see how healthcare is done right!

General Physical Requirements

• While performing the duties of this job, the employee is regularly required to stand; walk; use hands to finger, handle, or feel; reach with hands and arms and talk or hear.
• The employee is occasionally required to sit and stoop, kneel, crouch.
• The employee must regularly lift and/or move up to 10 pounds, frequently lift and/or move up to 25 pounds and occasionally lift and/or move up to 50 pounds.
• Work Environment: Combination of medical office and exam/procedure room settings.

OSHA Category
This position performs tasks that involve exposure to blood, body fluids, and/or tissues. All employees performing these duties are offered the opportunity to receive the Hepatitis-B vaccination series.