Registered Nurse Care Manager

Institute on Aging; California; On-site; USD 85,000 - 110,000; Full time

Job summary

Institute on Aging is seeking an RN Care Manager to support the HCBA Medi-Cal Waiver in Riverside and San Bernardino Counties. You will work with a multidisciplinary team to deliver hands-on, community-based care management for participants at risk of nursing home placement.

In this field-based role, you will conduct comprehensive assessments, develop plans of treatment, coordinate waiver services, and educate families while traveling to participants' homes.

Qualifications

• Comprehensive nursing health assessments of participants.
• Plan of Treatment development and care coordination.
• Travel across Riverside and San Bernardino Counties.
• Experience with Medi-Cal Waiver programs is preferred.
• Document and coordinate care using MedCompass.

Responsibilities

• Conduct comprehensive nursing health assessments of participants' medical, functional, cognitive, environmental, and social needs.
• Document assessments, case notes, and care coordination in MedCompass.
• Partner with participants, families, legal representatives, and physicians to build individualized care goals.
• Develop and implement a Plan of Treatment (POT), coordinating waiver services, publicly funded programs, and community resources.
• Travel throughout assigned region to meet participants where they live.
• Provide education, counseling, and advocacy to participants and their support systems.

Skills

Care coordination

Strong communication

Organizational skills

Travel readiness

Team collaboration

Education

RN license - California

BLS certification

Tools

MedCompass

Job description

*Transform Lives with Your Compassion and Expertise**Home Health RN – HCBA Program*RN Care Manager_*(Temporary, 3-6 Months, may become permanent) *_– Field-based, Riverside & San Bernardino Counties. _*If the position becomes permanent, benefits will be included.*_We're hiring an *RN Care Manager * supporting our HCBA Medi-Cal Waiver program. In this role, you'll be part of a multidisciplinary care team (nurse and social worker) providing hands-on, community-based care management to participants at risk of nursing home or institutional placement.*What You'll Do** Conduct comprehensive nursing health assessments of participants' medical, functional, cognitive, environmental, and social needs* Document assessments, case notes, and care coordination in MedCompass* Partner with participants, families, legal representatives, and physicians to build individualized care goals* Develop and implement a Plan of Treatment (POT), coordinating waiver services, publicly funded programs, and community resources* Identify and train backup caregivers for service gaps* Provide education, counseling, and advocacy to participants and their support systems* Monitor service delivery and quality through monthly contact and annual face-to-face reassessments* Follow up with participants after Emergency Department and inpatient admissions* Travel throughout your assigned region to meet participants where they live*What You'll Need** Current, unencumbered RN license in the State of California* Current BLS certification* Valid driver's license and proof of insurance, with willingness to travel throughout Riverside and/or San Bernardino County* Qualifying clinical experience (one of the following):* 1,000+ hours in the past 2 years in an acute care hospital, caring for individuals at the waiver's specified levels of care* 2,000+ hours in the past 3 years in an acute care hospital* 2,000+ hours in the past 5 years with a licensed and certified home health agency* 2,000+ hours in the past 5 years in another setting demonstrating equivalent knowledge and skill (per DHCS)* Experience setting patient care goals within a professional nursing process* Solid understanding of medical diagnoses and medications common to functionally impaired and older adults* Strong communication skills with patients, families, and care teams* Demonstrated case management experience in community-based healthcare* Excellent organization, prioritization, and computer skills*Nice to Have:** Experience with individuals facing mental health, behavioral health, or substance use challenges* Exceptional interpersonal and written communication skills*Why IOA* Join a team that's redefining what it means to age with dignity and independence._*Apply today to be part of a team where care is more than a service; it’s a promise.*__IOA reserves the right to adjust work hours or duties when appropriate.__Institute on Aging is an Equal Opportunity Employer. Institute on Aging is committed to cultivating a diverse and inclusive work environment and providing equal opportunities to all employees and job applicants without regard to age, race, religion, color, national origin, sex, sexual orientation, gender identity, genetic disposition, neuro-diversity, disability, veteran status or any other protected category under federal, state and local law.__Pursuant to the San Francisco Fair Chance Ordinance, we will consider for employment qualified applicants with arrest and conviction records._#IND94Job Types: Full-time, TemporaryWork Location: On the road