Job Description
About Us
We are a dedicated community-based health and care partner focused on improving the health and well-being of individuals, particularly within Black and Brown communities. Our team of local physicians, nurses, and caregivers collaborates to provide personalized care that goes beyond just treating symptoms. We believe that understanding our Family Members' race, culture, and environment is crucial to delivering better health outcomes. Our goal is to empower Family Members, providers, and caregivers, making health and care accessible and manageable every day. Join us in creating a better way to care!
About You
We are looking for an RN Case Manager who embodies the following qualifications:
Education: An active Registered Nursing license in California and a Bachelor of Science in Nursing (BSN) is required.
Experience: A minimum of five years of relevant clinical experience is necessary. Ideally, candidates will have over three years of care management experience in health plans, home health, or hospice settings.
Entrepreneurial Spirit: This role involves addressing longstanding gaps in care delivery for Black and Brown populations. You will play a vital role in ensuring our organization can deliver innovative solutions. The ideal candidate will be able to work independently and drive change.
Communication Skills: Excellent verbal and written communication skills are essential. You should be able to present concepts clearly and effectively.
Relationship Building: You will have the ability to build and manage relationships with patients, community leaders, and external stakeholders.
Cultural Fit: We seek individuals with good judgment, strong ethics, and a collaborative mindset, eager to thrive in a fast-paced, entrepreneurial environment.
About the Role
As an RN Case Manager, you will report to the Director of Clinical Operations and be responsible for providing strategic insights, organization, and evidence-based analysis to guide decisions and meet our requirements. You will embody our core values: Trust, Empathy, Commitment, Humility, Creativity, and Community Mindedness.
Key Responsibilities
Collaborate with an interdisciplinary team to achieve high-quality outcomes for our members and families dealing with chronic diseases.
Develop care pathway templates based on condition risk levels and member actions.
Create Member Action Plans using these templates, focusing on high-risk chronic conditions.
Conduct in-home or telehealth assessments as needed.
Respond promptly to member alerts and maintain active communication with members and caregivers through text and phone. Monitor remote patient tools and notify the team for necessary follow-ups.
Provide care coordination, including patient navigation, chronic disease management, and interdisciplinary collaboration, while adhering to policies and procedures.
Work closely with patients and care teams to develop Member Action Plans that prioritize patient and caregiver needs. Track outcomes and adjust plans as needed.
Engage patients in managing their health, medications, and treatment plans while facilitating referrals to community organizations.
Utilize evidence-based guidelines to close care gaps and determine when in-home services are required.
Employ the electronic medical record or care management platform for coordination activities and compliance with documentation standards.
Participate in team rounds to support ongoing program development and process improvement.
Reassess Member Action Plans post-discharge.
Adapt priorities effectively to manage patient care loads.
Collaborate with the interdisciplinary team on patient care planning and facilitation.
Perform additional job-related duties as assigned.
Additional Duties
Leadership: Lead the development and execution of strategies that create value in clinical practice. Work with your team to implement these strategies effectively.
Strategy: Establish a business strategy that improves member outcomes, enhances operational efficacy, and identifies market opportunities.
Collaboration: Ensure our clinical capabilities work cohesively by collaborating with other business divisions.
Knowledge: Provide expertise in clinical solutions, focusing on high-quality medical care and care management approaches.
Culture: Foster a productive, inclusive, and safe working environment for the clinical team and the broader organization.
Working Environment and Physical Requirements
This role involves both in-home and office-based work. Frequent travel for home visits, physician offices, hospitals, and community partners is required in various weather conditions. Office work is conducted in a traditional indoor setting with air conditioning and artificial lighting.
You should be able to travel frequently by car or public transportation and communicate effectively with customers, vendors, and colleagues in person and through devices, even in challenging situations. Regular use of telephone and email for communication is essential, along with the ability to sit for extended periods. You may need to lift up to 30 lbs. occasionally, and good manual dexterity is necessary for using common office equipment. Strong reasoning skills will help you understand and utilize management reports and other documents effectively.
Employment Type: Full-Time
Salary: $ 86,000.00 90,000.00 Per Year
Job Tags
Full time, Local area, Remote job, Home office,