RN Case Manager

Responsibilities

• Serves as a liaison among Brookdale teams, residents, families, and healthcare providers within our communities.
• Identifies, coordinates, communicates, and implements services essential for enhancing residents' quality of life and achieving an optimal level of wellness.
• Works closely with primary and specialty care providers to formulate resident-specific care plans.
• Serves as a resident advocate, contributing to identifying and improving service delivery, closing gaps in care, and understanding key interventions and care protocols.
• Edits and explains Brookdale’s care pathways based on individual diagnosis and healthcare needs.
• Maintains and communicates quality performance measures, and assists with training and education of teams to ensure quality outcomes for residents.
• Collaborates with healthcare providers and other healthcare entities to coordinate resources and supplies pertinent to resident needs.
• Reviews the current population’s medical diagnoses to identify care needs.
• Aids in assessing the health, functional, and psycho-social status of residents.
• Coordinates services required to enhance optimum wellness and manage chronic conditions.
• Collaborates with hospice, palliative, and home health services/therapy as indicated.
• Provides advanced care planning education to residents and families/responsible parties.
• Helps ensure each resident has a completed Advanced Care Plan, inclusive of goals of care.
• Communicates with healthcare providers to ensure care delivery is consistent with the resident’s Advanced Care Plan(s).
• Participates in collaborative care reviews (CCR) and care conferences.
• Provides resources for residents and families to make informed decisions regarding choices in meeting healthcare needs.
• Champions the benefits of residing and receiving care and services at the community.
• Applies quality improvement methodology to analyze, enhance, and manage outcomes, striving to achieve quality measure goals.
• Collaborates with Health and Wellness Directors (HWD) to ensure compliance with service plans, while working with providers to attain value-based outcomes for our residents.
• Coordinates and communicates care for each resident.
• Facilitates continuity of care for those residents receiving home health care, hospice services, and other third-party healthcare-related services.
• Completes documentation as required by Brookdale or state regulatory agencies.

Qualifications

• Graduate from Accredited Nursing School and a minimum of 5-7 years of relevant experience required.
• Knowledge of value-based care models is preferred.
• Experience working in SNF and HH environments preferred.
• Previous Care Management, Case Management, or Care Coordination preferred.
• RN license required.