RN Case Manager
Posted on: May 16, 2022
Job DescriptionAt WelbeHealth, we make the impossible, possible
for underserved seniors. We do this through utilizing and
developing cutting-edge healthcare and well-being service products
especially for seniors and their families. Now is your chance to
join our talented team that delivers unparalleled creative
healthcare, insurance, social support and more to seniors. We
create senior well-being through our courage to love, pioneering
spirit and shared intention. These values permeate everything we
do. At WelbeHealth, you'll help inspire that magic by enabling our
teams to push the limits of healthcare and well-being experiences
and create the never-before-seen!The Case Manager RN will work in
collaboration with the WelbeHealth interdisciplinary care team to
manage all aspects of care for WelbeHealth participants. The Case
Manager RN, either in-person or remotely; will manage complex
clinical situations, educate, assess, address patient needs, create
personalized care plans, communicate with participants and their
families, advocate for participants needs to be met, and provide
comprehensive coordinated care to all WelbeHealth participants. The
Case Manager RN functions as an independent Registered Nurse,
managing participant and family care needs with direction from the
Clinic Manager, Clinical Services Director, and Medical Director,
and is capable of understanding and explaining the WelbeHealth
program and model of care. The Case Manager RN adheres to
regulations and standards to ensure compliance with orders or
directives issued by duly constituted government and regulatory
agencies as well as WelbeHealth policies and procedures. In
addition, the Case Manager RN collaborates effectively with
colleagues and stakeholders to promote the WelbeHealth values, team
culture and mission.Duties and Responsibilities:
- Collect patient data and complete required forms with
appropriate responses according to clinic standards remotely or
- Identify patient's overt problems and needs and set priorities.
Identify problems requiring further referral and/or follow-up.
- Interpret and record latest diagnostic results; perform nursing
assessment using critical thinking skills.
- Assess documentation of medical records for completeness and
relationship to the care plan; identifies gaps or barriers in plans
- Telephonic assessment and education on chronic conditions
including end-stage renal disease.
- Plan care:
- Develop a plan of care based on nursing process, which
incorporates the plans of other disciplines and continuing care
needs and includes the patient and family in developing or revising
the plan of care.
- Complete initial and periodic assessments (minimally every 6
months) prior to the scheduled team meeting. Make referrals to
multidisciplinary support services.
- Communicate participant changes to team members including
post-procedure and post discharge calls.
- Create and update personalized care plans for patients, in
collaboration with patients' families, friends and social supports
in developing treatment plans.
- Implement and manage care:
- Conform to accepted practice standards with care provided and
implement correct treatments and procedures, and other care as
prescribed, according to patient care standards.
- Demonstrate understanding of age-related characteristics and
needs of patients served and explain nursing procedures in
- Provide participant and family education in coordination with
Nightly Navigator 24- hour care delivery. Identify emergency
situations and independently initiate therapies as needed.
- Act as a coordinator of care, on behalf of participants with
other health care personnel, with evaluation and follow up patient
care measures (i.e., dentures, glasses, personal care, procedures,
labs, referrals, or transportation).
- Understand and demonstrate respect for patient rights and
utilize established mechanisms for management of ethical issues in
- Proactively calls participants before weekends, holidays, or
procedures, or during long periods of remote care, as directed by
the Clinic Manager, CSD, or Medical Director.
- Record patient care delivered as planned to include any
variation, with appropriate rationale; make and record observations
and implement nursing measures related to impending or associated
- Evaluate new participant needs as they arise, document in the
EMR and care plan within directed timeframes and communicate
changes to the IDT.
- Master physical, psychosocial, and functional assessment skills
in a remote or inperson environment.
- Review results from medical tests and work with provider on
timely responses to participants.
- Using nursing process and delegate nursing care to appropriate
- Integrate cost effective measures into nursing practice.
- Recognize clinic problems and take responsibility for
documentation and communication of issues.
- Additional duties:
- Provide emotional support and empathy to families and
caregivers when communicating in-person or telephonically.
- Help manage participant complaints- call participants or family
to understand the problem and help find solutions.
- Possess familiarity and ability to use computers, remote
software platforms, and EMRs.
- Complete all required documentation in a timely and accurate
- Protect privacy and maintain confidentiality of all company
procedures and information\ about Team Members, participants and
- Other duties as assigned.Qualifications and Requirements:
- Graduate of an Accredited School of Nursing: Bachelor of
- Unencumbered California Registered Nurse (RN) License.
- Valid State Driver's License with a clean DMV record.
- Copy of recent Vehicle Insurance required.
- Minimum of two years nursing experience in a clinical setting
with a frail or elderly population.
- Nursing knowledge and skills necessary to treat frail, elderly
participants and manage complex clinical situations.
- Highly motivated, self-directed, able to execute tasks in a
quickly changing environment and make sound decisions in emergency
- Excellent clinical, organizational and communication skills in
settings with seniors, their families and interdisciplinary team
- Multi-tasks to contribute toward projects as well as respective
activities, timelines, and process improvement initiatives.
- Excellent organizational and communication skills.
- Ability to work independently with minimal supervision.
- Demonstrated ability to prioritize in a fast-paced
- Experience and competency working with people from diverse
backgrounds and cultures.
- Commitment to unlocking the full potential of our most
- Bilingual English/Spanish preferred. COVID-19 Vaccination
PolicyAt WelbeHealth, our mission is to unlock the full potential
of our vulnerable seniors. In this spirit, please note that we have
a vaccination policy for all of our employees and proof of
vaccination prior to employment is required. Our Commitment to
Diversity, Equity and InclusionAt WelbeHealth, we embrace and
cherish the diversity of our team members, and we're committed to
building a culture of inclusion and belonging. We're proud to be an
equal opportunity employer. People seeking employment at
WelbeHealth are considered without regard to race, color, religion,
sex, gender, gender identity, gender expression, sexual
orientation, marital or veteran status, age, national origin,
ancestry, citizenship, physical or mental disability, medical
condition, genetic information or characteristics (or those of a
family member), pregnancy or other status protected by applicable
Keywords: WelbeHealth, Pasadena , RN Case Manager, Healthcare , Pasadena, California
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