Case Manager, RN

Job description

WelbeHealth PACE helps seniors stay in their homes and communities by providing comprehensive medical care and community-based services. We serve the most vulnerable seniors with better quality and compassion in a value-based model, and the Lead Registered Nurse Case Manager directly guides this care as a primary voice on the interdisciplinary team (IDT). Reporting to the Clinical Nurse Manager, the Lead RN Case Manager delivers and oversees all aspects of participant care, including conducting required PACE assessments, developing and following personalized participant care plans, and supporting transition of care coordination. Essential Job Duties: - Serve as a preceptor and peer mentor for RN Case Managers at the direction of the clinic leaders - Take ownership of the outcomes and quality of care for assigned participant panels, working in tandem with the PCP and utilizing clinic resources - Conduct PACE required nursing assessments (minimally every 6 months), educating participants and their support network on acute, chronic, and end-stage conditions - Perform both urgent and routine virtual or in-person follow-up visits as determined by participants’ risk stratification and ne...