Registered Nurse Care Manager (Rn) - Orange County

"Every person deserves compassion, dignity, and the safety of a place to call home."
Homelessness is the largest social and public health crisis in California. Illumination Foundation (IF) is a growing non-profit organization dedicated towards disrupting the cycle of homelessness by providing targeted, interdisciplinary services in our recuperative care centers, emergency shelters, housing services and children's and family programs. IF currently has 13+ facilities with 22+ micro-communities scattered across Orange County, Los Angeles County, and the Inland Empire.
Job Description
The Registered Nurse Care Manager is responsible for assessing clients for recuperative care from the point of referral, identifying clinical and social needs and assisting with transition to the recuperative care setting. Once the client has been admitted to recuperative care, the RN Care Manager will be responsible for providing clinical oversight, promoting medication adherence and follow-up with primary care, behavioral health, and other specialists, and providing medical education to improve client independence with managing chronic conditions. The Nurse Care Manager will collaborate closely with a multidisciplinary care team, including providing clinical support to medical assistants, EMTs, and LVNs on the medical coordination team and case management staff. The RN Care Manager will collaborate with the broader care team (PCP, BH clinicians, etc.) to ensure that the enrollees are receiving needed services and measuring progress towards the goals outlined in their patient-centered care plan.
The pay range for this position is $66,560 - $80,000 per annum, depending on experience.
Responsibilities

• Provides support to the referral team to determine which clients are a good fit for Recuperative Care and Short-Term Post-Hospitalization programs
• Provides clinical support to case managers/medical coordinators. This includes chronic disease management and medication monitoring.
• Providing a bridge between the medical coordination staff and case management to create a more comprehensive care structure and providing guidance on appropriate external resources
• Provides clinical oversight and tracking for comprehensive intake assessments.
• Participates in developing patient-centered care plans for the enrollees on their panel.
• Works with hospitals to coordinate hospital admission/discharge plans with the behavioral health clinician, PCP, ACO, MCO, etc.
• Performs timely medication reconciliation following transitions in care. Supports medication adherence and education.
• Develops and implements new programs to provide more resources to clients, connecting with community-based organizations to develop new partnerships and determine creative ways to address client needs while in Recuperative Care and/or Short-Term Post-Hospitalization
• Uses data to evaluate outcomes from targeted interventions. Assists in developing appropriate adjustments to care plans based on this data.
• Implements prevention & engagement activities.
• Provides health coaching for groups of enrollees or individual enrollees as needed.
• Engages in quality improvement efforts.

Preferred Experience/ Minimum Qualifications
Required:

• Valid Registered Nurse (RN) license in California
• Experience working with vulnerable populations, including persons with a history of trauma, those experiencing socioeconomic stress, homelessness, or substance use disorders
• Strong interpersonal skills and clinical problem solving
• Comfort working in an autonomous clinical setting and nursing in an outreach setting
• Capability working with data to track and measure performance
• Basic computer skills, including the ability to send and receive emails and summarize data in spreadsheets.
• Valid CA Driver's License and eligibility for company vehicle insurance.

Preferred:

• Bachelor of Science in Nursing
• Care Management experience
• Bilingual in English and Spanish.
• Proficiency in Microsoft Office Suite (Outlook, Word, Excel, Teams).

Benefits

• Medical Insurance funded up to 91% by Illumination Foundation (Kaiser and Blue Shield), depending on the plan
• Dental and Vision Insurance
• Life, AD&D and LTD Insurance funded 100% by Illumination Foundation
• Employee Assistance Program
• Professional Development Reimbursement
• 401K with Company Matching
• 15 days vacation PTO/year
• 6 days sick PTO/year
• 10 days holiday PTO/year
• Potential eligibility for the Public Service Loan Forgiveness Program (PSFL) for federally qualified loans