Medical Case Manager (Case Mgt)

Summary of Need:

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