Care Manager, RN

Habitat Health empowers older adults to experience more good days in their homes and communities. Through the Program of All-Inclusive Care for the Elderly (PACE), we provide comprehensive medical care along with support for daily needs such as meals, transportation, and in‑home assistance. We deliver coordinated clinical and social care in our centers and directly in participants’ homes, creating a fully integrated experience that brings peace of mind and a true sense of belonging. As we expand our scalable, affordable PACE model to meet the growing and complex needs of aging populations, our mission‑driven care teams continue to help participants live well on their own terms. Habitat Health is supported by leading healthcare organizations and investors including New Enterprise Associates, Kaiser Permanente, and Town Hall Ventures. We are entering a period of significant growth and are looking for exceptional teammates to help us scale a better model of care for older adults. To learn more, visit Location: Sacramento, Open to out of state candidates- relocation bonus provided Position: Full-time Earn a $5,000 Bonus! $2,500 after 90-day training completion + $2,500 at 6 months. Role Scope: As the Care Manager (RN) you will be responsible for the management and delivery of direct nursing care to our participants in a variety of settings including, but not limited to, the clinic, adult day center, participant’s home, virtually, and SNF. You will serve as a critical member of the Interdisciplinary Team (IDT) and work collaboratively to complete assessments and drive forward participant care plans as “quarterback” for your panel. Core Responsibilities & Expectations for the Role Contribute to a center experience that Participants want to spend time in, a team culture that cares and creates joy, and an environment where all participants and team members belong. Continue to raise the bar. Constructively seek and share feedback and help us implement changes in order to improve clinical outcomes and experience for participants. Exhibit and honor Habitat’s Values. Participate and facilitate in Interdisciplinary Team (IDT) meetings by contributing insights from assessments, care plan recommendations, and care coordination in a collaborative spirit. Conducts face-to-face nursing assessments that are inclusive of physical, psychosocial, and behavioral statuses in various settings, primarily in the Habitat center but also in–home. In partnership with a medical provider, delivers personalized care for a panel of participants based on care plans. Delivers and documents nursing interventions as agreed upon in participant's care plans, promptly and accurately responding to physician orders, and correctly administering medications and therapeutic interventions. Provides case management longitudinally and during transitions of care. Proactively coordinates complex patient discharges, transfers, and immediate post-discharge needs with hospital and long-term care facility case managers Coordinates all aspects of care delivery including medication management, medical equipment and supplies, and specialist and diagnostic referrals Triages in the outpatient setting, which includes independently initiating therapies within scope of practice and collaboratively working with a medical provider to escalate care as needed. Educates participants, caregivers including family members, and team members on how to personalize and carry out care plans. Aid with all wound care (including complex wounds), IV (hydration, therapies), and any additional procedures within RN scope of practice identified to meet evolving participant needs. Delegates tasks to MA and Licensed Vocational Nurses within their respective scopes of practice. Remotely takes after-hour calls that are triaged on a rotating schedule. Performs related duties as assigned. Required Qualifications: Graduate of an accredited school of nursing; Bachelor of Science (BSN) preferred. Unencumbered California Registered Nurse (RN) license required. Minimum 2-4 years of experience clinically caring for medically complex or older adults’ population as an RN. Minimum 1-2 year's experience in case management. Strong clinical acumen in chronic disease management and complex geriatric care. Demonstrates experience in management of clinical interventions: wound care, IVs, phlebotomy, colostomy/ileostomy care, etc. Proof of medical clearance for communicable diseases, including a TB test. Proof of all immunizations are up to date. Proof of current CPR/BLS certification required or requirement to obtain within 30 days of employment. Proof of valid CA driver’s license, personal transportation, good driving record and auto insurance as required by State law. Preferred Qualifications: Alzheimer’s certification is preferred. Case Management certification preferred Bilingual: Spanish/Mandarin/Cantonese preferred. Compensation: The anticipated base salary range for this position is $55.00-$73.00/hour. The final compensation offered will be determined based on factors including, but not limited to, the candidate's qualifications, skills, experience, education, certifications, geographical location, and business needs. In addition, this position is eligible for a comprehensive benefits package, including medical, dental, and vision insurance; paid parental leave, short- and long-term disability coverage; life insurance; flexible spending accounts; a 401(k) savings plan that includes a match; paid time off; and company paid holidays. Vaccination Policy, including COVID-19 To help maintain a safe environment for our participants and team members, Habitat Health maintains vaccination and infection control policies applicable to certain roles and work locations. For COVID-19 and influenza, team members who are working in a participant care setting are required to provide either proof of vaccination or a signed declination form and comply with applicable masking requirements while in a care setting to the extent permitted by law in the applicable jurisdiction. Habitat Health will consider requests for reasonable accommodation based on an applicant's disability, medical condition, or sincerely held religious belief, practice, or observance in accordance with applicable law. As a condition of employment, team members are expected to comply with all applicable infection control protocols, personal protective equipment (PPE) requirements, and vaccination requirements associated with their role and work location, and to the extent required by law and as permitted in the applicable jurisdiction. Our Commitment to Equal Opportunity and Inclusion Habitat Health is an Equal Opportunity Employer committed to the principles of equal opportunity and inclusion. Employment decisions at Habitat Health are based on qualifications, merit, and business needs. We do not discriminate on the basis of race, color, religion, creed, sex, gender (including pregnancy, childbirth, breastfeeding, and related medical conditions), gender identity, gender expression, sexual orientation, marital status, registered domestic partner status, age, national origin, ancestry, citizenship, military or veteran status, physical or mental disability, medical condition, genetic information, reproductive health decision-making, or any other characteristic protected by applicable federal, state, or local law. Habitat Health is committed to the full inclusion of all qualified individuals. Consistent with applicable law, we provide reasonable accommodations to qualified individuals with disabilities and to individuals with religious beliefs, practices, or observances that require accommodation. If you require a reasonable accommodation to participate in the application or interview process, perform the essential functions of a position, or receive other employment benefits and privileges, please contact us at View email address on click.appcast.io. We encourage individuals from all backgrounds to apply, even if their experience does not align perfectly with every qualification listed. E-Verify Participation Notice Habitat Health participates in E-Verify and will provide the federal government with information from your Form I-9 to confirm your authorization to work in the United States. If E-Verify cannot confirm your authorization to work, Habitat Health will provide you with written instructions and an opportunity to contact the Department of Homeland Security (DHS) and/or the Social Security Administration (SSA) to resolve the issue before any adverse employment action is taken, including termination of employment. E-Verify is used only after an applicant has accepted an offer of employment and completed the Form I-9 and to the extent permitted by applicable law. Habitat Health complies with all federal and state employment eligibility verification requirements. Beware of Scams and Fraud Habitat Health is committed to protecting job seekers from recruitment scams. Please ensure that you submit applications only through Habitat Health's official careers website or authorized job boards. Official communications from Habitat Health recruiters and team members will come from email addresses ending in @habitathealth.com. Habitat Health will never ask applicants to pay fees, purchase equipment, or provide sensitive financial information as part of the recruiting or hiring process. If you receive suspicious communications claiming to represent Habitat Health, we encourage you to exercise caution and independently verify the communication before responding. If you believe you have been the victim of a recruitment scam or fraudulent job posting, please report the incident to the Federal Trade Commission (FTC) through its fraud reporting website at reportfraud.ftc.gov.