Nurse Care Manager

Join to apply for the Nurse Care Manager role at TieTalent1 day ago Be among the first 25 applicantsJoin to apply for the Nurse Care Manager role at TieTalentCompany Overview:Upward Health is an in-home, multidisciplinary medical group providing 24/7 whole-person care. Our clinical team treats physical, behavioral, and social health needs when and where a patient needs help. Everyone on our team from our doctors, nurses, and Care Specialists to our HR, Technology, and Business Services staff are driven by a desire to improve the lives of our patients. We are able to treat a wide range of needs – everything from addressing poorly controlled blood sugar to combatting anxiety to accessing medically tailored meals – because we know that health requires care for the whole person. It’s no wonder 98% of patients report being fully satisfied with Upward Health!AboutCompany Overview:Upward Health is an in-home, multidisciplinary medical group providing 24/7 whole-person care. Our clinical team treats physical, behavioral, and social health needs when and where a patient needs help. Everyone on our team from our doctors, nurses, and Care Specialists to our HR, Technology, and Business Services staff are driven by a desire to improve the lives of our patients. We are able to treat a wide range of needs – everything from addressing poorly controlled blood sugar to combatting anxiety to accessing medically tailored meals – because we know that health requires care for the whole person. It’s no wonder 98% of patients report being fully satisfied with Upward Health!Job Title & Role DescriptionThe Nurse Care Manager is responsible for comprehensive care coordination for high-risk patients in Contra Costa County. This role focuses on care planning, emergency department (ED) avoidance, and discharge planning for patients transitioning between levels of care. The Nurse Care Manager will work closely with patients, caregivers, health plans, and primary care providers to facilitate seamless care across settings and ensure continuity of services.This is a hybrid position with the autonomy to visit patients in their homes or at the hospital, as clinically appropriate. Additionally, the Nurse Care Manager will lead interdisciplinary team (IDT) meetings with a clinical focus to align care plans and support patient-centered outcomes.Skills RequiredActive, unrestricted Registered Nursing (RN) license in CaliforniaMinimum of 3-5 years of case management experience, including care planning and coordinationStrong knowledge of POLST, Advance Directives, and end-of-life planningExperience with home health, hospice, and care transitionsProficiency in electronic health record (EHR) systems and digital care management toolsExcellent communication and patient education skillsCritical thinking and decision-making abilities in complex care managementAbility to work independentlyExperience collaborating with health plans, PCPs, and community resourcesKey BehaviorsPatient-Centered Care:Develops strong relationships with patients and caregivers, advocating for their needs and ensuring they understand and follow care plans.CollaborationEffectively coordinates care with the patient’s health plan, primary care provider, and other care team members to optimize health outcomes.Proactive CommunicationActively engages patients and caregivers within 48 hours of hospital discharge to assess needs, update care plans, and mitigate potential readmission risks.Advocacy And EducationProvides clear, compassionate education to patients and families regarding POLST, Advance Directives, and available support services.Care CoordinationEnsures that care is effectively coordinated across multiple providers and services, particularly during transitions of care.Time ManagementEfficiently manages patient caseloads, balancing multiple tasks while adhering to established deadlines and care plans.Problem SolvingIdentifies potential gaps in care, collaborates with providers to resolve issues, and implements strategies to optimize patient outcomes.ConfidentialityMaintains patient confidentiality and follows HIPAA regulations in all communications and documentation.Cultural CompetenceDemonstrates respect for diversity, providing culturally sensitive care that meets the needs of diverse patient petenciesClinical Expertise:Strong knowledge of chronic disease management, care transitions, and evidence-based practices to develop and implement care plans.Effective CommunicationSkilled at delivering complex medical information clearly to patients, caregivers, and interdisciplinary teams.Care Plan DevelopmentProficient in creating personalized care plans that address physical, behavioral, and social health needs.Technology ProficiencyAbility to use electronic health records (EHR) and care management systems to document, track, and coordinate patient care.Outcome-OrientedFocused on achieving optimal clinical and financial outcomes for patients through effective care coordination and dependent And Team-OrientedAble to work independently while also collaborating effectively with a multidisciplinary team.Critical ThinkingUses clinical judgment to assess, analyze, and evaluate patient progress, adapting care plans as needed to achieve optimal results.Multitasking And PrioritizationManages multiple patient cases simultaneously while prioritizing tasks to meet deadlines and ensure comprehensive care.Patient EngagementMotivates patients to follow care plans and improve self-care skills through regular communication and support.Upward Health is proud to be an equal opportunity employer. We are committed to attracting, retaining, and maximizing the performance of a diverse and inclusive workforce. This job description is a general outline of duties performed and is not to be misconstrued as encompassing all duties performed within the pensation details: 100000-105000 Yearly SalaryPI093d5c456226-37648-37537710San Francisco, CaliforniaLanguagesEnglishSeniority levelSeniority levelMid-Senior levelEmployment typeEmployment typeFull-timeJob functionJob functionHealth Care ProviderIndustriesTechnology, Information and InternetReferrals increase your chances of interviewing at TieTalent by 2xSign in to set job alerts for “Nursing Manager” roles.San Ramon, CA $98,260.00-$205,260.00 2 months agoDirector Clinical Quality Improvement (CA Registered Nurse License)San Ramon, CA $150,000.00-$210,000.00 1 month agoNurse Manager - Mobile & Street MedicineRegistered Nurse, Care Manager and Wellness CoachDirector of Nursing - Operating Room / SurgicalSan Ramon, CA $98,260.00-$205,260.00 2 months agoAssistant Patient Care Manager (RN) - RWC Outpatient Pre/Post Care (Full-Time, 10-Hour Day Shifts)Hayward, CA $88,753.60-$99,905.40 11 hours agoRegistered Nurse Manager, Care Coordination, Full TimeAssistant Patient Care Manager (RN) - RWC Outpatient Pre/Post Care (Full-Time, 10-Hour Day Shifts)San Ramon, CA $135,000.00-$200,000.00 5 months agoTravel Home Health Case Manager RN - $2,909 per weekGreenbrae, CA $3,256.00-$3,256.00 4 days agoSchool-Based Registered Nurse (RN) - Hayward, CaliforniaRegistered Nurse - Pediatric Med/Surg FloatTravel Registered Nurse Cardiac Cath LabWalnut Creek, CA $2,564.60-$2,564.60 4 days agoNurse Manager - Bone Marrow Transplant ProgramClinical Services Manager I/II - Cordilleras Health and Healing CenterSan Mateo County, CA $133,764.80-$193,544.00 1 week agoManager Ambulatory Oncology and Specialty Operations - Full Time - 8 hour - Variable DaysWalnut Creek, CA $176,276.00-$264,415.00 1 month agoSan Francisco, CA $30.00-$36.00 6 months agoRegistered Nurse/Pediatric Acute Care Float PoolSr. Program Manager – Clinical ConstructionOakland, CA $124,400.00-$291,600.00 5 months agoWe’re unlocking community knowledge in a new way. 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Created: 2025-10-06