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Medicare RN Care Coordinator
2 months ago
RN Case Manager for Medicare Beneficiaries
Welcome Health is a pioneering primary care organization committed to enhancing healthcare for senior citizens. Our care model is grounded 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 who are assigned to us by the health plan or enroll directly. Our services are delivered in three environments: 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 is tasked with delivering ongoing case management to Medicare beneficiaries, concentrating on thorough care coordination to enhance patient outcomes and minimize healthcare expenses. The Case Manager will collaborate closely with patients, their families, and healthcare professionals to ensure effective management of chronic illnesses, adherence to treatment protocols, and decreased hospital readmissions and emergency department visits.
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 health status changes. Develop a comprehensive clinical case management strategy for each patient.
- Plan Evaluation and Revision: Gather feedback from providers, patients, and families as necessary, and adjust the care plan accordingly.
- Care Coordination: Oversee and manage detailed care plans for Medicare patients, ensuring continuity of care across various healthcare settings. 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 lower hospital readmissions by closely monitoring patient conditions and providing timely interventions.
- Emergency Room Visit Reduction: Create and execute plans to minimize unnecessary ER visits through proactive patient management and education.
- Quality Improvement: Participate in quality enhancement initiatives to improve patient care and meet essential performance metrics.
- Collaboration: Work in partnership 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 Advocacy: Act as an advocate for patients, ensuring their needs and preferences are respected and addressed.
- Documentation: Maintain precise and timely records of patient interactions, care plans, and outcomes in the electronic medical record (EMR) system.
Qualifications:
- A valid RN license in California and potentially other states where Welcome Health operates in the future.
- A Bachelor's degree in nursing (BSN) is preferred.
- A 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.
- Proficiency 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. They will report to the Vice President of Medical Affairs.
Benefits:
- Medical Insurance
- Dental Insurance
- Vision Insurance
- Life Insurance
- 401K
- Bonus Potential
- Salary: $105,000 - $135,000 per year
