Care Manager

🔥 4 minutes ago

🦀 Maryland – Remote

🦀 Maryland – Remote

💵 $70k - $85k / year

⏰ Full Time

🟡 Mid-level

🟠 Senior

👔 Manager

👻 Ghost score 0%

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Aledade, Inc.

WebsiteLinkedInAll Job Openings

501 - 1000 employees

Founded 2014

🏥 Healthcare

⚕️ Healthcare Insurance

🏢 Enterprise

Healthcare • Healthcare Insurance • Enterprise

Aledade, Inc. is a public benefit corporation that operates as the largest network of independent primary care practices in the United States. The company specializes in Accountable Care Organizations (ACOs), which help primary care practices and health centers improve patient outcomes and generate sustainable revenue through value-based care solutions. Aledade offers data insights, support, and business solutions to achieve sustainability and clinical autonomy. It collaborates with a wide range of healthcare providers, including primary care practices, community health centers, and network ACOs, ensuring improved quality of care and patient satisfaction. With operations in 45 states and affiliations with over 20,000 clinicians serving more than 2. 5 million patients, Aledade is committed to reducing care fragmentation and enhancing the overall quality of life for clinicians and patients alike.

📋 Description

• Conduct comprehensive longitudinal care assessments covering medical, behavioral, pharmaceutical, and social needs • Develop, maintain, and risk-stratify patient-centered care plans for an active longitudinal caseload • Deliver individualized education and self-management support using Motivational Interviewing techniques • Advocate for patients across the care continuum by building relationships with caregivers, practice clinicians, and community partners • Execute episodic and transitional care management outreach following inpatient discharges and ED encounters • Complete post-discharge medication reconciliations and facilitate face-to-face follow-up visits • Provide post-discharge follow-up support to reduce readmissions and emergency department utilization • Partner with primary care physicians and practice care teams to identify high-risk patients and co-design clinical care plans • Lead and participate in complex care rounds and interdisciplinary case reviews • Use CRISP ENS alerts and the Aledade App to monitor high-utilizer patients • Maintain closed-loop documentation within practice EHRs • Provide clinical oversight to non-licensed support staff and delegate care coordination tasks • Support population health initiatives • Monitor, measure, and drive clinical, financial, and functional quality metrics aligned with Maryland Primary Care Program standards

🎯 Requirements

• Current active licensed Registered Nurse in Maryland • 3-5 years of direct healthcare experience, preferably in home health, ambulatory care, community public health, case management, or care coordination across multiple settings with multiple providers • Proficiency with Health Information Exchanges (HIE), specifically CRISP ENS alerts, and predictive population health management tools • Certified Case Manager (CCM) credential or specialized training in Chronic Care Management (CCM) — encouraged • Demonstrated experience utilizing Motivational Interviewing (MI) techniques • Exceptional written and oral communication skills • Familiarity with the healthcare community being served, or a demonstrated commitment to learn it through on-the-ground networking and community assessment • Understanding of quality metrics • Knowledge and experience activating patients and teaching self-management skills • Experience working with vulnerable populations (geriatrics, minorities, behavioral health) • Ability to navigate ambiguity using structured problem-solving techniques • Ability to travel up to 20% across the year as needed to assigned primary care practices throughout Maryland and D.C., as well as to regional team retreats

🏖️ Benefits

• Flexible work schedules and the ability to work remotely are available for many roles • Health, dental and vision insurance paid up to 80% for employees, dependents and domestic partners • Robust time-off plan (21 days of PTO in your first year) • Two paid volunteer days and 11 paid holidays • 12 weeks paid parental leave for all new parents • Six weeks paid sabbatical after six years of service • Educational Assistant Program and Clinical Employee Reimbursement Program • 401(k) with up to 4% match • Stock options • Bonus • Regional team retreats