Job Description

Job Title: Bilingual Care Manager
Location: Sierra Vista, Arizona (must live within 30 miles). Must be comfortable driving to Nogales & Douglas occasionally
Salary: Competitive, based on experience plus performance-based bonus
Shift: Monday through Friday, hybrid model with in-home visits

The Care Manager Registered Nurse is a key member of an integrated Care Team alongside an Advanced Practice Provider and Social Worker. This role focuses on serving patients with chronic kidney disease and end-stage renal disease who often have multiple complex conditions. The RN provides in-home care management, builds strong patient relationships, and supports improved health outcomes through proactive, value-based care.

This position blends in-home visits with remote coordination and emphasizes slowing disease progression, improving quality of life, and reducing avoidable hospitalizations.

Key Responsibilities:

• Develop and continuously adapt individualized care plans in collaboration with medical providers
• Conduct in-home care management visits to implement and monitor care plans
  
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  Monitor biometric data and initiate interventions per approved protocols
• Reconcile medications and coordinate with pharmacists and prescribers
  
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  Perform patient health assessments and required surveys
• Provide education on CKD, ESRD, dialysis, and related comorbidities
  
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  Encourage medication adherence and ongoing patient engagement
• Serve as primary point of contact for patients during business hours
  
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  Support advance care planning and ESRD treatment discussions
• Obtain vital signs during visits and escalate concerns appropriately
  
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  Conduct post-hospital and post-operative transition visits
• Document care activities and patient progress in care management platform
  
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  Coordinate transitions with dialysis providers and other specialists

Required Qualifications:

• Active Registered Nurse license in the state of employment
• Graduate of an accredited School of Nursing
  
• Minimum of 2 years of experience in care management and/or CKD or ESRD patient care
  
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  Basic Life Support certification required
  
• Ability to travel locally for frequent in-home visits
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  Ability to take remote call on some nights and weekends
  
• Strong communication skills and ability to build patient relationships
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  Self-motivated with ability to work independently
• Proficiency with Microsoft Office and web-based documentation platforms
  

Benefits:

• Flexible scheduling with hybrid and in-home model
• Competitive compensation with performance-based bonus program
• Comprehensive medical, dental, vision, and life insurance
• 401(k) with employer matching
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  Paid vacation and holiday time
• Opportunity to work in an innovative, patient-centered value-based care organization