RN Case Manager for Medicare Patients
Welcome Health is an advanced primary care organization dedicated to transforming care for older adults. Our model of care is steeped in the science of geriatric medicine. As a risk bearing organization, we contract primarily with Medicare Advantage plans to significantly improve access to and quality of care of members who are 65 years and older who are assigned to us by the health plan or enroll directly. Our care is provided in 3 settings: patient homes, clinics/facilities and virtually. We are hiring an RN Case Manager to support our physician-led interdisciplinary teams in following patients longitudinally and mitigating their risk for poor outcomes such as hospitalizations.
The Case Manager is responsible for providing longitudinal case management to Medicare patients, focusing on comprehensive care coordination to improve patient outcomes and reduce healthcare costs. The Case Manager will work closely with patients, their families, and healthcare providers to ensure effective management of chronic conditions, adherence to treatment plans, and reduced hospital readmissions and emergency room visits.
Location: Southern California, Hybrid Role (remote, in facilities and patient homes). We anticipate that approximately 80% of this role will be performed remotely.
Employment Type: Full time, exempt
We are looking for people who are:
- Big-hearted
- Positive
- Willing to take (measured) risks
- Deeply dissatisfied with the status quo of American healthcare
- Committed to empathy-driven behaviors, with teammates and patients
- Able to balance humility with confidence
- Trustworthy
- Hardworking
- Curious enough to listen thoughtfully before speaking
- Willing to assume others’ best intentions
- Resilient
- Caring communicators
- Strong clinical assessment and critical thinking skills.
- Excellent communication and interpersonal skills.
- Proficient in using electronic medical records (EMR), case management software and Microsoft Excel & PowerPoint.
- Ability to work independently and as part of a multidisciplinary team.
- Knowledge of Medicare regulations and quality metrics (e.g., HEDIS, CMS Star Ratings).
How You Can Help Our Patients
Welcome Health RN Case Manager is an integral part of our physician-led, multi-disciplinary teams. To thrive in this environment, you will take pride in the following:
- Comprehensive Case Management: Collaborate in the patient care process to assess, plan, facilitate, coordinate, monitor, and evaluate options and services to meet members' health needs.
- Care Transition Support: Support members or their representatives regarding care, care transitions, and changes in health status. Implement a comprehensive clinical case management plan for each patient.
- Plan Evaluation and Revision: Obtain input from providers, patients, and families as appropriate, and evaluate and revise the plan as needed.
- Care Coordination: Coordinate and manage comprehensive care plans for Medicare patients, continuity of care across various healthcare settings. Track and evaluate patient outcomes and adjust care plans as necessary.
- Patient Education: Educate patients and their families about chronic disease management, medication adherence, and self-care techniques. Promote preventive health measures and wellness programs.
- Treatment Plan Adherence: Monitor patient compliance with treatment plans and intervene as necessary to improve adherence.
- Hospital Readmission Reduction: Implement strategies to reduce hospital readmissions by closely monitoring patient conditions and providing timely interventions.
- Emergency Room Visit Reduction: Develop and execute plans to reduce unnecessary ER visits through proactive patient management and education.
- Quality Improvement: Participate 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, other healthcare team members including case managers who work in our partnered Managed Services Organization (MSO) to ensure coordinated and efficient care delivery.
- Patient Treatment: On occasion and within the bounds of state regulations and licensure requirements, directly deliver nursing care.
- Documentation: Maintain accurate and timely documentation of patient interactions, care plans, and outcomes in the electronic medical record (EMR) system.
- Patient Advocacy: Act as a patient advocate, ensuring that patients' needs and preferences are respected and addressed.
- Variance Analysis and Reporting: Analyze patient variances from the plan and initiate appropriate steps to resolve variances. Track and report key performance indicators to assess program effectiveness. Participate in developing programs to improve performance.
- Admission and Concurrent Stay Reviews: Perform admission and concurrent stay reviews on hospitalized patients.
- Discharge Planning: Develop and implement discharge planning for patients in conjunction with hospital-based case managers.
- Telephonic and On-site Reviews: Perform telephonic, fax, and/or on-site reviews with skilled nursing facilities, home health agencies, or other contracted service agencies to determine the need for continued care.
What You’ll Need to Succeed as a Welcome Health RN Case Manager
- A current RN license in California and other states within which Welcome Health practices 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 strongly preferred.
- Fluency in a second language such as Spanish, Korean, Armenian, or Mandarin Chinese is preferred.
The RN Case Manager plays a critical role in Welcome Health’s clinical quality, patient service and overall success. They will report to the Vice President of Medical Affairs.
Welcome Health provides equal employment opportunities to all employees and applicants for employment and prohibits discrimination and harassment of any type without regard to 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 include:
- Medical Insurance
- Dental Insurance
- Vision Insurance
- Life Insurance
- 401K
- Bonus Potential
- Salary: $105,000.00 - $135,000.00 per year
