RN Case Manager

1 day ago

Silver Spring Maryland, Wayne County, MI, United States Riderwood Village by Erickson Senior Living Full time

Location:

Riderwood Village by Erickson Senior Living

This is NOT a remote or hybrid opportunity

The Centers for Medicare and Medicaid Services (CMS) has awarded Erickson Advantage an overall 5-star rating for the fifth consecutive year Join our 5-star rated team as a RN Case Manager (also known as Care Coordinator, Erickson Advantage at Erickson Senior Living) that will be supporting, identifying, and evaluating health plan members at risk for, or experiencing, adverse health events and chronic disease. The Care Coordinator will provide appropriate and necessary interventions to ensure that the member is receiving maximum benefit from health services in a cost-effective setting.

What we offer

  • A culture of diversity, inclusion, equity and belonging, which builds on our mission, vision and values
  • Medical, dental and vision packages, including an annual reimbursement for qualified wellness expenses, personal health coaching and telemedicine options
  • PTO Plans, PLUS company paid volunteer hours for eligible team members, in accordance with applicable state law
  • 401k for all team members 18 and over with a company 3% match
  • Onsite medical centers, providing wellness visits and sick care for all team members over 18 years of age
  • Free access to our on-site Team member Health and Well-Being Centers, plus Well-Being programs, tools and resources for you and your immediate family members
  • Education assistance, certification reimbursement and access to over 6,000 courses through our online learning library, designed to enhance your current skills and build new ones
  • Growth Opportunities – grow with the company as we open new communities and expand on our existing ones

Compensation: Commensurate with experience, range is $77-95k per year with annual bonus potential opportunity

How you will make an impact

  • Facilitates efficient care for targeted Erickson Advantage health plan members in a variety of settings, focusing on returning the member to the safest and highest level of independence possible.
  • The Care Coordinator utilizes a variety of interventions and coordinates care for targeted health plan members with a variety of providers in a variety of care settings.
  • Works closely with members who have multiple or poorly managed chronic disease/s as defined target diagnoses in the health plan Policies and Procedures.
  • Assesses the high-risk member’s current medical circumstances, provides information about health care options, serves as guide and advisor to the patient and their family, and establishes and molds the relationship with the primary care physician and the patient
  • Through risk stratification, high-risk members will be identified, and a case opened for members who meet the criteria for care coordination services.
  • Works with the primary care physician to establish protocols for routine and preventive care which reflect accepted standards of care
  • Facilitates the development of customized care plans through collaboration between the primary care physician, the health plan member, and other health care team providers, including specialists, vendors, and ancillary healthcare providers
  • As a member of the care delivery team works to facilitate health plan member compliance and ensure continuity of care per the team’s “care plan”.
  • Reassesses the effectiveness, quality of services, and treatments provided, per health plan Policies and Procedures
  • Adjusts the plan of care to reflect problems, interventions, goals, and outcomes.
  • The Care Coordinator will measure case performance based on program goals, objectives, quality indicators, and patient-specific outcomes.
  • Researches and selects care options as appropriate. The nurse care coordinator may utilize a range of alternative, non-medical services (i.e., diabetic education, cardiac rehabilitation, and dietary instruction) and treatments. The care coordinator may also make recommendations for alternative medical care for approval by the primary care physician.
  • Assists health plan members and their families in selecting care options by providing information about providers, services and treatments, risks, and potential results involved with options.
  • Maintains a comprehensive, computerized medical and social history for assigned patients. Information will be used for such activities as patient assessment, care planning, patient/care evaluation, case tracking, and risk prediction, as well as cost analyses. A software system will be utilized to enhance communications among the health care team.

What you will need

  • Active Professional Licensed RN required. CCM certification or working toward.
  • Minimum 5 years clinical experience (medical/surgical, community health nursing, home health care) and/or 3 years case management and/or UR experience preferred.
  • Knowledge of health care and insurance industries and health care delivery systems, including current standards of medical practice; insurance benefit structures and related legal/medical issues; and utilization review and quality assurance procedures.

Please note that specific state regulations and requirements may be applicable. These regulations take precedence over the requirements outlined in the job description.

Riderwood is a beautiful 120-acre continuing care retirement community in Silver Spring, Maryland. We’re part of a growing national network of communities managed by Erickson Senior Living, one of the country’s largest and most respected providers of senior living and health care. Riderwood helps people live better lives by fulfilling our promises of a vibrant lifestyle, financial stability, and focused health and well-being services for those who live and work with us. As part of our team, you'll enjoy flexibility and work-life balance to meet your personal and professional goals, and we are committed to providing you with opportunities to learn and grow.

Erickson Senior Living, its affiliates, and managed communities are Equal Opportunity Employers and are committed to providing a workplace free of unlawful discrimination and harassment on the basis of race, color, religion, sex, age, national origin, marital status, veteran status, mental or physical disability, sexual orientation, gender identity or expression, genetic information or any other category protected by federal, state or local law

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