The RN Case Manager is a critical member of our healthcare team, specializing in overseeing and coordinating comprehensive care for residents in a Community Based Care setting. This role involves managing all aspects of nursing care on assigned floors, conducting assessments, and ensuring the delivery of personalized and high-quality care. The RN Case Manager acts as a liaison among residents, families, and healthcare providers, and is instrumental in supporting direct care staff through education and quality assurance activities. This position requires adaptability to respond to urgent care needs and a commitment to maintaining regulatory compliance as per Oregon state guidelines. In addition, serves as Manager on Duty during swing shift after hours (5:00 PM – 10:00 PM), reporting concerns and operational issues to appropriate on-call staff.

• Full-time
• On-site at our assisted living facility (Macdonald Residence)
• Tuesday through Saturday- Swing shift (2-10:30 PM)

Duties and Responsibilities

Care Coordination

• Lead the care coordination for the assigned floor, overseeing all aspects of the residents medical, behavioral, and activities of daily living care needs.
• Oversee the daily medical needs, complete physical assessments, wound care, self-medication, durable medical equipment, and various other assessments as applicable to the residents needs and in coordination with the OARs.

Resident Assessments and Service Plans

• Complete the preadmission and admission requirements for residents moving on the assigned floor.
• Perform comprehensive assessments on new residents and conduct ongoing evaluations of physical and psycho-social needs.
• Build and ensure the care delivery of the residents individual person-centered Negotiated Services Agreements, following the OAR guidelines.
• Oversee the Temporary Service Plans following the change of condition OAR guidelines.

Resident Engagement

• Assist in facilitation of resident care conferences.
• Serve as a liaison between residents, families, and physicians to coordinate care needs.

Interdisciplinary Coordination

• Collaborate with state Case Managers, APS, Ombudsman, pharmacy, home health, hospice, and medical professionals to ensure cohesive and quality resident care.
• Participate in IDT workgroups, collaborating and contributing to the organizational quality outcomes.
• Assist in tracking. trending. and improving organizational goals, quality metrics, and state outcomes.

On-Call After Hours

• Participate in on-call shifts after hours to provide RN oversight for resident and guide the medication technicians on non-pharmacological, pharmacological, and medical interventions
• Direct the medication technicians on emergency response for residents.

Documentation and Compliance

• Supervise the maintenance of resident charts and ensure accurate documentation by staff.
• Utilize PointClickCare documentation and electronic health records effectively.
• Support policy, procedure, and protocol implementations.

Regulatory Adherence and Community Outreach

• Adhere to all state and federal regulations and guidelines.
• Conduct offsite assessments, including visits to hospitals, homeless camps, shelters, skilled nursing facilities and personal homes.
• Assist in maintaining compliance and contributing to the development of survey plans of correction. 

Other

• Serves as Manager on Duty during swing shift after hours (5:00 PM – 10:00 PM), reporting concerns and operational issues to appropriate on-call staff.
• Additional duties may be assigned.

Qualifications/ Requirements

• Knowledge of Oregon Community based Care regulatory compliance and healthcare laws preferred.
• Excellent communication and interpersonal skills.
• Understanding of privacy and confidentiality of information pertaining to residents, employees, company information and records.
• Ability to assess patients' needs, support in developing care plans, and monitor progress.
• Ability to analyze complex situations, identify solutions and make informed decisions.
• Efficiently managing multiple cases and prioritizing tasks in a timely manner.
• Demonstrated ability in working effectively with other staff and working independently with little supervision.
• Ability to be objective and treat staff in a fair and equitable manner.
• Experience working with individuals who demonstrate challenging behaviors.
• Experience in behavioral health and/or community-based care settings.
• Ability to assess residents' behavioral health needs, support in developing care plans, and monitor progress.
• Experience working with individuals who demonstrate challenging behaviors in a behavioral health setting.
• Experience in addiction support, including providing specialized care and recovery planning for residents with substance use disorders.
• BSN preferred
• Certifications preferred but not required include:
  • Psychiatric- Mental Health Nursing Certification (PMH-BC)
  • Certified Addictions Registered Nurse (CARN)
  • Certified Clinical Trauma Professional (CCTP)
• Proficiency in electronic health records and case management software.
• Registered Nurse (RN) licensure in Oregon required.
• First Aid and CPR Certified
• Ability to be on-call as needed.

Physical Requirements

The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions listed above.

• Regularly requires use of hands or various tasks such as typing, handling objects, and operating equipment.
• Clear verbal communication and adequate hearing.
• Frequently involves sitting and reaching with hands and arms.
• Occasionally stand, walk, and move, bending, kneeling, stopping, and crouching within the work environment.
• Frequently lift objects up to 10 pounds and occasionally lift or move objects up to 25 pounds.
• Specific vision abilities needed for this job include close vision, depth perception, and the capacity to adjust focus, such as when reading or working on a computer.

The environment is characteristic of a facility in which healthcare is provided to the vulnerable adults and individuals requiring additional assistance due to special needs. The noise level is usually moderate.

Benefits/perks

• Health insurance (paying 100% of the employee's health premiums, and offering dependent coverage options)
• Employer Paid Life and Disability Insurance
• 401(k) option which is available upon 60 days of service and matches employee contribution $1/$1 up to 4%
• Monthly Tri-Met or parking pass
• Generous PTO policy (10 paid holidays and over 5 weeks of Paid time off)
• Employee Assistance Program
• Flexible Spending Account
• Meal provided while on site during work shift.

Compensation

Starting hourly rate: $41.82 – $54.00 (+ shift differential for hours worked between 6pm and 6am)