Illumination Foundation
Location
Riverside, CA | United States
Job description
“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 Case 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 $65,000-80,000 per year, depending on experience.
Tasks/Responsibilities:
Provides clinical support to the referral team to determine which clients are a good fit for Recuperative Care and Short-Term Post-Hospitalization programs
Engages vulnerable populations as part of a multidisciplinary outreach team. This includes home visits, outreach to hospitals, homeless shelters and other settings, as needed.
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.
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 Google Suite (Mail, Docs, Sheets, Calendar).
Benefits
401(k) w/ company matching
Employee assistance program
Flexible spending account
Health, dental, life and vision insurance
Generous PTO
Referral program
Tuition reimbursement
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