Medical Case Manager

Job Summary

Health is seeking a highly motivated and experienced TEMP to join our team. Case Management is an advanced specialty collaborative practice responsible for providing ongoing case management services. The role will facilitate communication and coordination among all participants of the health care team members to ensure the services provided promote quality and cost-effective outcomes for all members. The incumbent will be responsible for providing intensive case management, which includes assessment, planning, implementation, coordination, monitoring, and evaluation of the member's needs.

Duties & Responsibilities

• Care Management
  
  
  
  • Assess member needs using a standardized health needs assessment or health risk assessment.
  • Perform comprehensive, disease-specific, clinical assessments of all identified cases, including physical, functional, social, and psychological status, cultural and linguistic needs, caregiver resources, and available benefits.
  • Conduct post-discharge assessments to identify member's needs, including physical, functional, social, and psychological status, cultural and linguistic needs, caregiver resources, and available benefits.
  • Ensure follow-up provider care and scheduled appointments, durable medical equipment and supplies, and community resources.
  • Develop and implement a member's specific care plan with prioritized SMART goals.
  • Review, modify, and update care plans continuously to reflect the member's needs, at a minimum, annually or upon change in condition.
  • Schedule follow-ups to assess progress towards goals and identify barriers to meeting goals.
  • Provide regular outreach to assigned members and evaluate the quality of service given to members.
  • Coordinate care and services with members, family members/representatives, and other providers, including community supports and LTSS.
  • Communicate with member's physicians, specialists, community agencies, and vendors for service coordination.
  • Facilitate referrals to behavioral health/substance use disorder services and make referrals to LTSS department, community supports, and resources.
  • Participate in Interdisciplinary Team meetings as applicable and collaborate with interdepartmental staff in case resolution.
  • Identify cases needing supervisor, manager, director, or medical director review or input and close cases according to procedures and guidelines in a timely manner.
  • Advocate in the member's best interest for necessary funding, treatment alternatives, timelines, and coordination of care and frequent evaluations of progress and goals.
  
  
  
  
• Administrative Support
  
  
  
  • Participate in a mission-driven culture of high-quality performance with a member focus on customer service, consistency, dignity, and accountability.
  • Assist the team in carrying out department responsibilities and collaborate with others to support short- and long-term goals/priorities for the department.
  • Follow protocol for documenting all case interventions.
  • Prepare and maintain appropriate documentation of patient care and progress within the care plan.
  
  
  
  
• Other
  
  
  
  • Complete other projects and duties as assigned.
  
  
  
  

• Associate degree in nursing (ADN) or related field required PLUS 3 years of clinical experience and/or managed care experience required; an equivalent combination of education and experience sufficient to successfully perform the essential duties of the position may also be qualifying.

• Bachelor of Science in Nursing (BSN) degree or related field.
• Case Management Certification (CCM).
• Bilingual in English and one defined threshold languages (Arabic, Chinese, Farsi, Korean, Spanish, Vietnamese).

• Current, unrestricted Registered Nurse (RN) license to practice in the state of California required.

• Develop rapport and establish and maintain effective working relationships with leadership and staff and external contacts at all levels and with diverse backgrounds.
• Work independently and exercise sound judgment.
• Communicate clearly and concisely, both orally and in writing.
• Work a flexible schedule; available to participate in evening and weekend events.
• Organize, be analytical, problem-solve, and possess project management skills.
• Work in a fast-paced environment and in an efficient manner.
• Manage multiple projects and identify opportunities for internal and external collaboration.
• Motivate and lead multi-program teams and external committees/coalitions.
• Utilize computer and appropriate software (e.g., Microsoft Office: Word, Outlook, Excel, PowerPoint) and job-specific applications/systems to produce correspondence, charts, spreadsheets, and/or other information applicable to the position assignment.

• Ability to visually read information from computer screens, forms, and other printed materials and information.
• Ability to speak clearly in conversation and general communication.
• Hearing ability for verbal communication/conversation/responses via telephone, telephone systems, and face-to-face interactions.
• Manual dexterity for typing, writing, standing, and reaching, flexibility, body movement for bending, crouching, walking, kneeling, and prolonged sitting.
• Lifting and moving objects, patients, and/or equipment.

• Medical Insurance
• Vision & Dental insurance
• Life Insurance
• 401K
• Commuter Benefits
• Employee Discounts & Rewards
• Payroll Payment Options