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RN Case Manager

Company: WelbeHealth
Location: Pasadena
Posted on: May 16, 2022

Job Description:

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:

  • Assessment:
    • Collect patient data and complete required forms with appropriate responses according to clinic standards remotely or in-person.
    • 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 of care.
    • 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 appropriate forms.
        • 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 patient care.
        • 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.
        • Evaluate:
          • 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 problems.
          • 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.
          • Lead:
            • Using nursing process and delegate nursing care to appropriate personnel.
            • 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 manner.
              • Protect privacy and maintain confidentiality of all company procedures and information\ about Team Members, participants and families.
              • Other duties as assigned.Qualifications and Requirements:
                • Graduate of an Accredited School of Nursing: Bachelor of Science (BSN).
                • 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 situations.
                • Excellent clinical, organizational and communication skills in settings with seniors, their families and interdisciplinary team members.
                • 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 environment.
                • Experience and competency working with people from diverse backgrounds and cultures.
                • Commitment to unlocking the full potential of our most vulnerable seniors.
                • 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 law.

Keywords: WelbeHealth, Pasadena , RN Case Manager, Healthcare , Pasadena, California

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