Clinical Nurse Coach

Specialty Care Management (SCM) is a purpose-driven organization addressing some of the most complex and costly challenges in healthcare: kidney disease and renal dialysis. With 1 in 7 U.S. adults estimated to have chronic kidney disease (with many progressing to dialysis), SCM partners with health plans to manage these high-risk, high-cost claims through a platform of predictive data analytics, proactive clinical programming, and financial cost-containment and claims underwriting. Our aligned goal across stakeholders is to lower costs and improve member health.

As a Clinical Health Coach, your role is central to SCM’s clinical efforts, collectively designed to deploy best in class clinical methodologies and coaching methods to improve patient health. You’ll be interacting with patients at all stages of kidney disease: pre-disease (addressing common co-morbidities); CKD Stages 1-5; ESRD. A Clinical Health Coach has strong assessment skills, a firm command of the nursing process and a passion for empowering members to improve their self-care as the means to identify and reduce their risk for ESRD. Clinical Health Coaches make proactive outreach and regular follow-up calls to members who carry complex (and often multi-morbid pathophysiology) with compassion and effectiveness. Our RNs are expected to work to the top of their licensure for the benefit of members, families, and employer groups served by our kidney disease management programs. In addition, you’ll act as the clinical expert to support Sales and Operations teams from time-to-time.

Possess a firm command of nursing processes and work full-circle with each member: Obtain member health assessment and history via telephone or secure video chat using motivational interviewing and a coaching framework. Gather and utilize pertinent medical records including laboratory data and communicate discrepancies back to MD/providers. Utilize industry guidelines to provide and ensure high-quality and appropriate care. Utilize tools/formulas to calculate key metrics and facilitate risk identification (GFR, KFRS, UPCR-UACR, etc.) Develop care plans and evaluations to ensure your members are on the right track. Develop good relationships with providers, family/support persons, and all members of the care team to provide education and support. Ensure timely nephrology, community and hospice referrals, optimal start for dialysis/avoidance of emergency start dialysis, and be able to identify and communicate variance in guidelines associated with kidney and dialysis care. Facilitate and coordinate care with other providers and large case management. Perform chart reviews and contribute to continuous quality improvement and ongoing program development. Provide Medicare advocacy and education for members with ESRD. Perform claims reviews and eligibility verification of case load each month. Track key personal performance metrics each quarter and maintain a minimum of 35%-member participation rates with assigned case load for our CKD management program. Mine for and compile cost savings KPI reports each quarter. Utilize critical thinking, clinical judgement, and personal time management skills. Attend and participate in case conferences and intra/inter departmental training and meetings. Stay current with industry, KDIGO and KDOQI guidelines for kidney disease care and management. Adhere and comply with HIPAA regulations in a remote-working environment. Maintain current and unrestricted RN license(s) and liability insurance Work cross-functionally withing SCM, including Client Experience & Marketing, to assist in providing feedback and developing programming, advocating for clinical perspectives.