RN Care Manager

Habitat Health empowers older adults to experiencemore gooddays 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, andin ‑ homeassistance. 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, ourmission ‑ drivencare 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 Schedule: Monday - Friday Role Scope : The RN Care Manager delivers personalized, longitudinal nursing care to a panel of PACE participants, conducting face-to-face assessments across physical, psychosocial, and behavioral domains in both center and home settings, and partnering with medical providers to implement care plans. This role manages care coordination end-to-end, collaborating and coordinating with the entire care team as needed. As a collaborative participant andleaderin Interdisciplinary Team (IDT) meetings, this role contributes clinical insights that inform whole-person care planning and educates participants, caregivers, and team members on carrying out personalized care plans — all while contributing to a center culture grounded in Habitat's values and participant belonging 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 n Interdisciplinary Team (IDT) meetings by contributing insights from assessments, care plan recommendations, and care coordination in a collaborative spirit. Conduct 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–homeas needed. In partnership with a medical provider, deliver personalized care for a panel of participants based on care plans. Deliver and document nursing interventions as agreed upon in participant's care plans, promptly and accurately responding to physician orders, and correctly administering medications and therapeutic interventions. Provide case management longitudinally and during transitions of care. Proactively coordinate complex patient discharges, transfers, and immediate post-discharge needs with hospital and long-term care facility case managers . Coordinate all aspects of care delivery including medication.management, medical equipment and supplies, and specialist and diagnostic referrals Triage in the outpatient setting, which includes independently initiating therapies within scope of practice and collaboratively working with a medical provider to elevate care as needed. Educate 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. Delegate tasks to MA and Licensed Vocational Nurses within their respective scopes of practice. Optiontoparticipateinafter-hour calls that are triaged on a rotating schedulefor extra compensation. Perform related duties as assigned. Required Qualifications: Graduate of an accredited school of nursing or equivalent experience. 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 current CPR/BLS certification required or requirement to obtain within 30 days of employment. A minimum of one year experience working with the frail or elderly. Aligns with our purpose and our values, and is excited about living those out in daily practice Ability to thrive in a fast-paced, evolving environment with comfort navigating ambiguity, adapting quickly, and contributing to continuous improvement. Strong learning and growth mindset, including seeking feedback, engaging in healthydebateand using data and curiosity to inform decisions. Acts with integrity and ownership, considering the broader organizational impact, doing the right thing, and following through to deliver results. Nice to have: Bachelor’sof Science (BSN) preferred. PACE experience and/ or ADCH/CBAS experience. A state issued driver’s license, personal transportation, and auto insurance as required by law. Essential Functions & Physical Requirements: The following statements describe the general nature of work and physical expectations common across roles at Habitat Health. Specific responsibilities may vary by position. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. Team members in this role may be expected to: Work in healthcare, administrative, community, or remote environments, depending on role needs. Communicate effectively with participants, caregivers, team members, and other stakeholders in person, by phone, and through electronic systems. Remain stationary or move about for extended periods, consistent with job duties. Operate standard office equipment and/or clinical tools (e.g., computers, phones, medical devices, documentation systems). Travel between work sitesorcommunity locations as needed. Follow safety procedures, infection control protocols, and use personal protective equipment (PPE) whenrequired. Perform tasks that may involve bending, reaching, lifting, orassistingparticipants, depending on role responsibilities. Lift, carry, push, or pull supplies, equipment, or materials typically up to 25–50 pounds, withassistanceor mechanical aids, depending on job duties and role responsibilities. Compensation: The anticipated base salary range for this position is $55.00 - $73.00 / per hour . This position is also eligible for a target annual bonus of 5% of the annual salary and may be eligible foradditionalincentive compensation, as applicable. The final compensation offered will bedeterminedbased 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-termdisability coverage; life insurance; flexible spending accounts; a 401(k) savings planthat includes a match; paid time off; and companypaid holiday To helpmaintaina safe environment for our participants and team members, Habitat Healthmaintainsvaccination 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, orsincerely heldreligious belief, practice, or observancein accordance withapplicable 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 tothe 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 requirea reasonableaccommodation toparticipatein 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. Habitat Healthparticipatesin 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 completedthe FormI-9and to the extentpermittedbyapplicable law. Habitat Healthcomplies withall federal and state employment eligibility verification requirements. Voluntary Self-Identification For government reporting purposes, we ask candidates to respond to the below self-identification survey.Completion of the form is entirely voluntary. Whatever your decision, it will not be considered in the hiringprocess or thereafter. Any information that you do provide will be recorded and maintained in aconfidential file. As set forth in Habitat Health’s Equal Employment Opportunity policy,we do not discriminate on the basis of any protected group status under any applicable law. If you believe you belong to any of the categories of protected veterans listed below, please indicate by making the appropriate selection.As a government contractor subject to the Vietnam Era Veterans Readjustment Assistance Act (VEVRAA), we request this information in order to measurethe effectiveness of the outreach and positive recruitment efforts we undertake pursuant to VEVRAA. Classification of protected categoriesis as follows: A "disabled veteran" is one of the following: a veteran of the U.S. military, ground, naval or air service who is entitled to compensation (or who but for the receipt of military retired pay would be entitled to compensation) under laws administered by the Secretary of Veterans Affairs; or a person who was discharged or released from active duty because of a service-connected disability. A "recently separated veteran" means any veteran during the three-year period beginning on the date of such veteran's discharge or release from active duty in the U.S. military, ground, naval or air service. An "active duty wartime or campaign badge veteran" means a veteran who served on active duty in the U.S. military, ground, naval or air service during a war, or in a campaign or expedition for which a campaign badge has been authorized under the laws administered by the Department of Defense. An "Armed forces service medal veteran" means a veteran who, while serving on active duty in the U.S. military, ground, naval or air service, participated in a United States military operation for which an Armed Forces service medal was awarded pursuant to Executive Order 12985. #J-18808-Ljbffr Habitat Health