Geriatric Care Manager (RN, LPN, or LSW Required)

Bluestone Physician Services

Minnesota

In loco

USD 69.000 - 80.000

Tempo pieno

14 giorni+

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Vantaggi offerti da questo lavoro

Health Insurance

Dental Insurance

Vision Materials Insurance

Company paid Life Insurance

Company paid Short and Long-term Disb

Health Savings Account (HSA)

Flexible Spending Account (FSA)

Retirement plan with 4% matchingcontr

Nine paid holidays + floating holiday

Paid Time Off (PTO) 15 days

Mileage reimbursement for field staff

Company cell phone, laptop

Descrizione del lavoro

Bluestone Physician Services is seeking a Geriatric Care Manager to support complex, chronically ill patients in senior living communities. The role focuses on 1:1 patient management, care coordination, and close collaboration with families and primary care providers to execute unified care plans.

This full-time, field-based position covers communities across Minnesota, Wisconsin, and Florida, with 90% community-based duties and a daytime schedule.

Competenze

Bachelor’s degree or higher and active licensure (LPN/RN/SW).
3–5 years direct clinical experience in geriatric care or post-acute settings.
Behavioral health experience is preferred.
Strong communication and independent work capability.

Mansioni

Care coordination and development of comprehensive care plans.
Collaborate with MDs, NPs, and PAs for care updates.
Manage transitions and reduce readmissions.
Engage in patient, family, and facility education.
Ensure regulatory compliance and care model integrity.

Conoscenze

Time management

Professional relationships

Effective communication

Computer proficiency

EHRs experience

Independence

Formazione

Bachelor’s degree or higher

Licensed personnel (LPN/RN/SW)

3–5 years direct geriatric care experience

Descrizione del lavoro

Bluestone delivers great outcomes by bringing exceptional care to patients living with complex, chronic conditions and disabilities. Our unique, robust model of care goes beyond primary care services — our multidisciplinary care teams collaborate with patients, their families and other healthcare providers to deliver care that is preventative, proactive and tailored to their unique needs.

Using an evidence-based approach focused on quality care management and data-driven medical decisions, Bluestone care teams collaborate to manage patients’ chronic conditions, address social determinants of health, manage transitions to and from inpatient settings, provide behavioral health support and more. Under our model of care, Bluestone patients experienced 21% fewer ER visits, 36% fewer hospitalizations and 41% fewer hospital readmissions compared to patients with similar conditions and complexities over the same time period.

Our care teams travel directly to patients who reside in Assisted Living, Memory Care and Group Home communities throughout Minnesota, Wisconsin and Florida and are supported by clinical operations and administrative colleagues who work remotely or at our corporate offices in Stillwater, Minnesota, and Tampa, Florida.

Our success is only possible through the hard work of our employees who bring our core values of Dedication, Excellence, Collaboration and Caring to life every day. Bluestone has been named to the Star Tribune's Top Workplace list for the 14th year in a row! Bluestone also achieved Top Workplace USA 2021-2026! In 2022, Bluestone Accountable Care Organization (ACO) was the best performing ACO in the country as measured by the overall savings per Medicare beneficiary.

Position Overview

Focused on the 1:1 relationship and patient management. The Geriatric Clinical Care Manager is a specialized, field-based care team member responsible for supporting the management of complex and chronically ill patients and behavioral health conditions within senior living communities. Serving as the primary link between the patient, the family, and the Primary Care Provider, this role ensures a single, unified care plan is executed. The Care Manager is accountable for optimizing patient outcomes, closing gaps in care, and reducing unnecessary hospitalizations for a complex, chronically ill population.

Schedule

Full time position, day shift hours, no evenings, weekends or holidays. Hours are 8am to 5pm Monday thru Thursday & 8am to 3pm on Fridays.

Location

This position is 90% field-based direct patient care, mainly throughout Minnetonka, Golden Valley, Edina, Plymouth, Orono, and St Louis Park areas.

Salary Range

$68,500 - $80,000. Salary commensurate with experience.

Responsibilities

Care Coordination

Care Plan Development: Develop and manage individualized, comprehensive care plans that align with
organizational standards and program requirements. Support patients and families with honest advance care
planning discussions and goal setting.
Behavioral Health Management: Execute on CoCM model and implement specific behavioral health
interventions.
Clinical Partnership: Collaborate directly with MDs, CNPs, and PAs to provide real-time observations and update
care strategies based on the patient’s evolving status.
Gaps-in-Care & Utilization Management: Proactively identify and close clinical and documentation gaps to
support Value-Based Care (VBC) contracts, including ACO initiatives. Take accountability for meeting quality
measures, optimizing performance benchmarks, and preventing unnecessary utilization to effectively manage
the Total Cost of Care (TCOC).

Operational Excellence & Coordination

Transition Management: Lead the coordination of hospital and rehab discharges to ensure seamless transitions,
focusing on the prevention of 30-day readmissions.
Acute Care Facilitation: Manage on-site acute visit coordination, including the facilitation of telehealth services
to ensure timely clinical interventions.
Resource Optimization: Navigate and deploy community and organizational resources to support the patient’s
ability to remain in their home. Ensure patients are aligned with the most optimal Bluestone care management
program available.

Community, Patient & Family Support

Education: Provide expert guidance to families and facility staff regarding dementia, mental health concerns, and
the Bluestone care model.
Relationship Management: Serve as a point of care management contact, ensuring communication is streamlined and the patient and community experience is consistent.

Care Model Integrity

Care Model Adherence: Ensure all care management activities satisfy regulatory requirements.
Field-Based Efficiency: Maintain high-visibility presence within assigned communities (90% field-based)

Qualifications

Education/Certification/Experience

Bachelor's degree or higher preferred. Licensed personnel Required - LPN, RN, or Licensed Social Worker.
Strong preference for candidates with 3–5 years of direct clinical experience in geriatric care, acute care, post-acute care, or health system discharge planning.
Experience in behavioral health preferred.

Knowledge/Skills/Abilities

Knowledge and experience with Assisted Living and Memory Care communities
Ability to work independently with excellent time-management and organizational skills
Ability to maintain professional relationships members of the care team
Ability to communicate effectively and professionally, both verbally and in writing, with diverse populations
Advanced-level of computer proficiency with email, fax, word processing, spreadsheets, and databases
Strong technical skills and experience with EHRs preferred
Demonstrated compatibility with Bluestone’s mission and operating philosophies
Demonstrated ability to read, write, speak, and understand the English language

Bluestone Benefits