RN Case Manager

At DAP Health, we are committed to transforming lives and advancing health equity for all. As a leading nonprofit health care provider, we deliver compassionate, high-quality care to the diverse communities of the Coachella Valley and San Diego County. Our comprehensive services range from primary care to mental health, wellness programs, and beyond, with a focus on those who are most vulnerable. Joining our team means becoming part of a passionate, innovative organization dedicated to making a meaningful impact in the lives of those we serve. If you're looking for a dynamic and purpose-driven environment, we invite you to explore the opportunity to contribute to our mission.

Job Summary

The RN Case Manager serves as an advocate and care coordinator for at-risk patients, including those being discharged from the hospital, managing chronic disease non-compliance, newly diagnosed with chronic disease or cancer, frail, elderly, or frequent emergency room utilizers. The RN Case Manager is responsible for conducting an in-depth assessment of a client's needs and providing appropriate

interventions to improve outcomes, ensure access to care, reduce re-hospitalization, and offer support systems for the management of the condition.

Supervisory Responsibilities: None

Essential Duties/Responsibilities

• Conduct a thorough needs assessment based on the risk factor or diagnosis provided at the time of referral - this may include a medical history, functional abilities, and social components including family support systems, ability to function independently, ability to obtain medication and understand the prescription, language skills and medical insurance status
• Arrange and coordinate various services based on the needs of the patient - these may include public or private programs, not-for-profit organizations, transportation, in home support services, medical insurance, patient and family education, home health, medication use, and others
• Assist with paperwork necessary to obtain services
• Maintain adequate knowledge of resources available and conduct additional research when indicated or necessary to resolve complex cases
• Act as an advocate between agencies and clients to ensure timely interventions and develop a collaborative relationship to maximize the patient's and family's ability to make informed decisions
• Demonstrate the knowledge base necessary regarding resources and health care services to appropriately assist the client and communicate effectively with the medical team
• Demonstrate ability to manage the case through the continuum of care towards providing timely interventions and an appropriate outcome
• Provide adequate care coordination, effectively communicate the interventions and progress with the health care team, and conduct timely follow-up assessments
• Maintain appropriate documentation including but not limited to client information, diagnosis, and medical history, communication with service providers, details of the referrals issued, plans, goals, and outcomes
• Make recommendations for changes in the direction of projects based on informed and acquired knowledge of trends and community changes
• Conduct or participate in community meetings as deemed appropriate for the current assignments or potential opportunities of development
• Integrate support functions effectively with the clinic services and operations
• Assist with opening new opportunities for funding or program growth by staying informed and establishing a network of community resources
• Participate in organizational performance improvement projects related to current activities and annual MA Clinical Skills Competency Training events
• Provide patient and clinic support on a case-by-case basis to surrounding clinics
• Offer patient and clinic support as part of the call center RN Triage coverage and assist with special projects requiring RN expertise as needed
• Develop and monitor departmental and program/project operating budgets, costs and schedules
• Supervise, lead, coach, and use best management practices to improve staff performance
• Support and model the identified vision, values, and behaviors of the organization
• Work with staff to develop systems to ensure consistent, high-quality project management
• Other duties as assigned

Safety

• Ensure compliance with policies and procedures related to safe work practices
• Use appropriate equipment and/or tools to ensure workplace safety
• Immediately report unsafe working conditions

Privacy/Compliance

• Maintain privacy and security of all patients, employee, and volunteer information and access to such information
• Comply with all regulations regarding corporate integrity and security obligations
• Report unethical, fraudulent, or unlawful behavior or activity
• Uphold strict ethical standards

Required Skills/Abilities

• Demonstrate excellent oral and written communication skills
• Proficient in thoroughly documenting conversations and actions related to case management
• Exhibit effective interpersonal skills
• Ability to work effectively in collaboration with diverse groups of people
• Proficient in performing mathematical calculations, organizing, and prioritizing workload
• Ability to work effectively and efficiently under stress
• Capable of handling difficult situations with professionalism
• Shows integrity, positive attitude, mission driven attitude, and is self-directed with a demonstrated passion for DAP Health's mission and commitment to working collaboratively with the executive team
• Basic business intuition and common sense
• Strong work ethic
• Skilled in supervising, multitasking, and following instructions
• Proficient in reading, writing, speaking, and understanding English
• Bilingual in Spanish and English is preferred

Education and Experience

• RN Degree
• At least 2 years' work experience in Case Management or related field
• Strong technical knowledge of management principles and practices

Working Conditions/Physical Requirements

• Capable of lifting and moving up to 40 pounds, moving between locations, and standing for extended periods
• Hybrid schedule: 3 days in clinic and 2 working remotely