Accompany Health is on a mission to give low-income patients with complex needs the dignified, high-quality care they deserve but rarely receive. A primary, behavioral, and social care provider, Accompany Health walks alongside patients for their entire care journey, offering at-home and virtual care, as well as 24/7 support. Partnering with innovative payors, Accompany Health is powered by remarkable care teams, elegant technology, and a commitment to evidence-based practice. 

We build long-term relationships with our patients so they know, without question, that our team is here for them day or night, year after year. We focus on the health outcomes most important to our patients to make it clear that they lead the way.

To achieve our mission, we collaborate with community-based organizations, local providers, and health plans. Led by our empathetic care teams, guided by proven care models, and powered by our own technology, we deliver a level of service that our communities rightfully deserve but rarely receive. 

While our headquarters is in Bethesda, MD, our teams are distributed across the country. If you’re eager to make a tangible difference in people’s lives, to help correct long-standing disparities in health care, join us. 

About the role:

The RN manager will be a key part of our Integrated Care Teams, which also include Physicians, Advanced Practice Clinicians, Community Health Workers, Patient Experience Navigators, RNs, Social Workers, Behavioral Health Clinicians, Psychiatrists, and Pharmacists. Together this team is responsible for providing and coordinating holistic, patient-centered care for an intimate panel of patients with complex medical, behavioral health, and social needs. 

As the RN manager, you will split your time between RN team supervision (25%) and direct clinical care (75%). Our RNs serve as key members of our Interdisciplinary Care Teams providing coordinated medical, behavioral, and social care for complex patients. Accompany Health RN services cover three main areas: clinical triage and case management, care transitions support, and chronic disease management.

In addition to providing the clinical services above, as RN manager you will provide day-to-day supervision and coordination for our RN team to ensure excellent care and team success. You will utilize data tools and analysis to both organize daily activities and provide quality assurance. You will meet regularly with clinical and operational leadership to review program performance, identify improvement opportunities, and support the implementation of new workflows.

Responsibilities will include:

• Providing day-to-day support for our RN team, including reviewing dashboards to understand capacity needs, managing the flow of clinical triage & care transitions follow up, and troubleshooting issues that arise.
• Reviewing RN Program performance data and workflows regularly with clinical and operational leadership to ensure the highest level of patient experience, clinical care, and safety and support team success.
• Partnering with clinical leadership, operational and IT teams to provide feedback on data tools and EHR templates to support excellent clinical care and efficient workflows
• Monitoring and improving our care transitions and chronic disease management workflows (e.g. diabetes, CHF, COPD, and CKD) to ensure timely completion of clinical assessments, patient education, quality gap closure, and medication adherence. 
• Caring for our patients through phone-based clinical triage, case management and care transitions (e.g. hospital discharge) follow up. 
• When needed, performing in-home patient clinical assessments and chronic disease support. 
• Providing case management for complex patients through in person and virtual care, in collaboration with our multi-disciplinary care teams to address medical, behavioral, and social needs
• Participating in multi-disciplinary case conferences and clinical rounds to ensure holistic, appropriate, coordinated and patient-centered care. This may include providing training to team members such as community health workers and medical assistants on clinical topics.
• Providing feedback on program design and workflows to ensure we are providing the best patient care possible.
• Ensuring timely and appropriate documentation.
• Roles and responsibilities may evolve as our care model develops. 

• Passionate about caring for complex, historically underserved patients with co-occurring chronic and behavioral health conditions 
• Team player who enjoys working in an integrated, multi-disciplinary model 
• Excellent communicator able to coach and mentor clinical and non-clinical members of multidisciplinary teams on excellent patient care. 
• Committed to providing the highest quality, outstanding clinical care and willing to go the extra mile for all patients.
• Excited to be a part of a rapidly evolving, innovative care model
• Comfortable with technology

• Required
• Active, unrestricted Registered Nurse license in the state of Michigan
• 5 years of experience providing clinical services to Adult and/or Geriatric individuals with co-occurring chronic medical and behavioral health conditions, preferably in a home-based setting
• 3 years of experience managing clinical staff
• Skill in prioritizing the demands of daily operations, organizing resources, and coaching staff to achieve their full potential
• Exceptional clinical assessment and triage skills, particularly for complex and high need patients
• Demonstrated ability in coordinating care plans and providing health education for common chronic medical conditions such as diabetes, hypertension, CHF, COPD, and CKD.
• Familiarity and willingness to travel as needed within your community (home-based member visits) and its healthcare systems (hospitals and rehab centers)
• Proficiency in utilizing electronic health records and telehealth platforms; Ability to adapt to new technologies/software
• Valid unrestricted driver's license and access to an insured vehicle for daily use

• Preferred 
• Strong analytical skills and ability to leverage data-driven insights to inform decision-making and drive quality improvement efforts
• Strong organizational and time management skills, with the ability to be detail oriented, and prioritize tasks effectively in a fast-paced environment.
• Experience in one or more of the following: home-based nursing care, ambulatory primary care, care transitions, care management, interdisciplinary care team care, behavioral health and trauma-informed care. 
• Experience in quality improvement projects, change management initiatives or healthcare start up environments

For Patient Facing Roles

To keep our patients, communities and each other safe, you'll be required to comply with Accompany Health’s medical clearance requirements, including completing a TB screen and providing proof of immunity or vaccination for certain conditions. You will also be required to be vaccinated and up-to-date on your COVID-19 vaccinations, including boosters. This is a condition of employment, and we make exceptions as required by law. Accommodation for religious and medical beliefs will be provided on a case by case basis.

For Non-Patient Facing Roles

To keep our patients, communities and each other safe, you'll be required to comply with Accompany Health’s medical clearance requirements, including receiving the COVID-19 vaccine. This is a condition of employment, and we make exceptions as required by law. Accommodation for religious and medical beliefs will be provided on a case by case basis.

We embrace diversity and believe it creates a healthier atmosphere: Accompany Health is an Equal Employment Opportunity employer and all qualified applicants will receive consideration for employment without regard to race, color, religion, sex, age, national origin, protected veteran status, disability status, sexual orientation, gender identity or expression, marital status, genetic information, or any other characteristic protected by law.