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Medicare RN Case Manager
2 months ago
Position: RN Case Manager for Medicare Patients
Welcome Health is a pioneering primary care organization committed to enhancing healthcare for older adults. Our approach is grounded in the principles of geriatric medicine. As a risk-bearing entity, we primarily partner with Medicare Advantage plans to significantly enhance access to and quality of care for members aged 65 and older, whether assigned by the health plan or enrolling directly. Our services are delivered across three settings: patient residences, clinics/facilities, and virtually. We are seeking an RN Case Manager to assist our physician-led interdisciplinary teams in monitoring patients over time and reducing their risk for adverse outcomes, such as hospital admissions.
The Case Manager will be responsible for delivering ongoing case management to Medicare patients, emphasizing comprehensive care coordination aimed at improving patient outcomes and minimizing healthcare expenditures. This role involves close collaboration with patients, their families, and healthcare providers to ensure effective management of chronic illnesses, adherence to treatment protocols, and a reduction in hospital readmissions and emergency department visits.
Work Environment: This position is based in Southern California and operates in a hybrid model (remote, in facilities, and patient homes), with approximately 80% of the work conducted remotely.
Employment Type: Full-time, exempt
Ideal Candidates Will Exhibit:
- Compassionate nature
- Positive outlook
- Willingness to embrace calculated risks
- Strong dissatisfaction with the current state of American healthcare
- Commitment to empathetic interactions with colleagues and patients
- Ability to balance humility with self-assurance
- Trustworthiness
- Diligence
- Curiosity and active listening skills
- Assumption of positive intent from others
- Resilience
- Effective communication skills
- Strong clinical assessment and analytical skills
- Proficiency in electronic medical records (EMR), case management software, and Microsoft Excel & PowerPoint
- Capability to work independently and collaboratively within a multidisciplinary team
- Familiarity with Medicare regulations and quality metrics (e.g., HEDIS, CMS Star Ratings)
Key Responsibilities:
- Comprehensive Case Management: Engage in the patient care process to assess, plan, facilitate, coordinate, monitor, and evaluate options and services to meet members' health requirements.
- Care Transition Support: Assist members or their representatives with care transitions and changes in health status. Develop a detailed clinical case management plan for each patient.
- Plan Evaluation and Revision: Gather feedback from providers, patients, and families as appropriate, and adjust the care plan as necessary.
- Care Coordination: Oversee and manage comprehensive care plans for Medicare patients, ensuring continuity of care across various healthcare environments. Monitor and assess patient outcomes and modify care plans as needed.
- Patient Education: Inform patients and their families about chronic disease management, medication adherence, and self-care strategies. Advocate for preventive health measures and wellness initiatives.
- Treatment Plan Adherence: Track patient compliance with treatment plans and intervene as necessary to enhance adherence.
- Hospital Readmission Reduction: Implement strategies to minimize hospital readmissions by closely monitoring patient conditions and providing timely interventions.
- Emergency Room Visit Reduction: Create and execute plans to decrease 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 (e.g., HEDIS, CMS Star Ratings).
- Collaboration: Work collaboratively with primary care providers, specialists, and other healthcare team members, including case managers from our partnered Managed Services Organization (MSO), to ensure coordinated and efficient care delivery.
- Patient Treatment: Occasionally provide direct nursing care within the limits of state regulations and licensure requirements.
- Documentation: Maintain accurate and timely records of patient interactions, care plans, and outcomes in the electronic medical record (EMR) system.
- Patient Advocacy: Serve as a patient advocate, ensuring that patients' needs and preferences are respected and addressed.
- Variance Analysis and Reporting: Analyze patient variances from the care plan and initiate appropriate actions to resolve discrepancies. Track and report key performance indicators to evaluate program effectiveness and contribute to the development of performance improvement initiatives.
- Admission and Concurrent Stay Reviews: Conduct admission and concurrent stay reviews for hospitalized patients.
- Discharge Planning: Collaborate with hospital-based case managers to develop and implement discharge plans for patients.
- Telephonic and On-site Reviews: Perform telephonic, fax, and/or on-site reviews with skilled nursing facilities, home health agencies, or other contracted service providers to assess the need for continued care.
Qualifications:
- Current RN license in California and other states where Welcome Health may operate 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 is strongly preferred.
- Fluency in a second language such as Spanish, Korean, Armenian, or Mandarin Chinese is preferred.
The RN Case Manager is vital to Welcome Health's clinical quality, patient service, and overall success. This position reports to the Vice President of Medical Affairs.
Welcome Health is an equal opportunity employer, providing equal employment opportunities to all employees and applicants for employment while prohibiting discrimination and harassment of any kind based on race, color, religion, age, sex, national origin, disability status, genetics, protected veteran status, sexual orientation, gender identity or expression, or any other characteristic protected by federal, state, or local laws.
Benefits:
- Medical Insurance
- Dental Insurance
- Vision Insurance
- Life Insurance
- 401K
- Bonus Potential
- Salary: $105,000 - $135,000 per year
