Medicare RN Care Coordinator

1 week ago


Los Angeles, California, United States Welcome Health, Inc Full time

RN Case Manager for Medicare Patients

Welcome Health is a pioneering primary care organization committed to enhancing healthcare for senior citizens. Our care model is rooted in the principles of geriatric medicine. As a risk-bearing entity, we primarily engage with Medicare Advantage plans to significantly enhance access to and quality of care for members aged 65 and older, whether assigned by health plans or through direct enrollment. Our services are delivered across three environments: patient residences, clinics/facilities, and virtually. We are seeking an RN Case Manager to assist our physician-led interdisciplinary teams in managing patients over time and reducing their risk of adverse outcomes such as hospital admissions.

The Case Manager will be responsible for delivering ongoing case management to Medicare patients, emphasizing thorough care coordination to enhance patient outcomes and lower healthcare expenses. This role involves close collaboration with patients, their families, and healthcare professionals to ensure effective management of chronic illnesses, adherence to treatment protocols, and a decrease in hospital readmissions and emergency department visits.

Key Responsibilities:

  • Comprehensive Case Management: Collaborate in the patient care process to assess, plan, facilitate, coordinate, monitor, and evaluate options and services to meet members' health needs.
  • Care Transition Support: Assist members or their representatives regarding care, transitions, and changes in health status. Implement a comprehensive clinical case management plan for each patient.
  • Plan Evaluation and Revision: Gather input from providers, patients, and families as appropriate, and evaluate and revise the plan as needed.
  • Care Coordination: Oversee and manage comprehensive care plans for Medicare patients, ensuring continuity of care across various healthcare settings. Track and evaluate patient outcomes and adjust care plans as necessary.
  • Patient Education: Inform patients and their families about chronic disease management, medication adherence, and self-care techniques. Promote preventive health measures and wellness initiatives.
  • Treatment Plan Adherence: Monitor patient compliance with treatment plans and intervene as necessary to improve adherence.
  • Hospital Readmission Reduction: Implement strategies to minimize hospital readmissions by closely monitoring patient conditions and providing timely interventions.
  • Emergency Room Visit Reduction: Develop and execute plans to reduce unnecessary ER visits through proactive patient management and education.
  • Quality Improvement: Engage in quality improvement initiatives to enhance patient care and meet key performance indicators.
  • Collaboration: Work collaboratively with primary care providers, specialists, and other healthcare team members to ensure coordinated and efficient care delivery.
  • Patient Advocacy: Act as a patient advocate, ensuring that patients' needs and preferences are respected and addressed.
  • Documentation: Maintain accurate and timely documentation of patient interactions, care plans, and outcomes in the electronic medical record (EMR) system.

Qualifications:

  • A current RN license in California and other states where Welcome Health operates in the future.
  • Bachelor's degree in nursing (BSN) preferred.
  • Minimum of 3 years of clinical nursing experience, with at least 2 years in case management or care coordination.
  • Experience in Medicare Advantage health plan case management strongly preferred.
  • Fluency in a second language such as Spanish, Korean, Armenian, or Mandarin Chinese is preferred.

The RN Case Manager plays a vital role in Welcome Health's clinical quality, patient service, and overall success. They will report to the Vice President of Medical Affairs.

Benefits include:

  • Medical Insurance
  • Dental Insurance
  • Vision Insurance
  • Life Insurance
  • 401K
  • Bonus Potential
  • Salary: $105,000 - $135,000.00 per year


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