- Full Time/Contract
- Utilization Management
- Rancho Cucamonga, CA
Our Client is a not-for-profit, rapidly growing Medi-Cal and Medicare health plan serving over 1,138,447 residents of the Riverside and San Bernardino counties. Our client maintains a Positive Team Culture as demonstrated by being voted by Los Angeles News Group readers as "Favorite Overall Company to Work For , "Favorite Training Program , and "Favorite Workplace Culture in their 2014 Winning Workplaces survey.
CARE MANAGER – RN / LVN
Under the general direction of the Care Management Manager, the Care Manager is responsible for working directly with the Plan, IPA medical groups, providers, hospitals, community agencies, Members/caregivers, and other entities supporting Member care to ensure coordinated, continuous care and serve as a resource person to these facilities. The RN / LVNCare Manager supports the care team, finalizes the care management assessment and Individualized Care Plan (ICP).
- Responsible for serving as a resource for Members and Providers for care management and continuity of care.
- Responsible for assessing Members for appropriate care management needs:
- Conduct clinical assessment and medication reconciliation.
- Develop, implement, and evaluate individualized care plans (ICP)
- Review and revise contributions to assessment information and care planning from care team members (i.e. LVN Care Manager, Care Coordinator) as appropriate
- Act as a Member advocate
- Serve as a liaison between Member, caregivers, and providers
- Educate and support Members/caregivers with meeting ICP goals
- Identify need for Interdisciplinary Care Team (ICT), organize the participants to be included and ensure facilitation and documentation of the ICT.
- Review and revise contributions to assessment information and care planning from care team members (i.e. LVN Care Manager, Care Coordinator) as appropriate.
- Assist with referrals for Members that are eligible for carve out programs such as CCS, multi-organ transplant, etc
- Assist members with immediate needs with regard to access, referrals and authorizations.
- Assist member with resources such as LTSS, Independent Living and Diversity Services, Behavioral Health, and Community Resources
- Responsible for any other duties as required ensuring successful care management processes and Member outcomes using critical thinking and innovative techniques to engage and retain Members in the CM program.
- Any other duties as required or assigned to ensure Health Plan operations are successful.
- Ensure the privacy and security of PHI (Protected Health Information) as outlined in 's policies and procedures relating to HIPAA compliance.
SKILLS & QUALIFICATIONS
- Valid RN or LVN licensed issued by the State of California
- Three (3) or more years of care management experience in a health care delivery setting.
- Experience in an HMO or experience in Managed Care setting preferred.
- Minimum 1 year clinical experience in an acute care facility, skilled nursing facility, home health or clinic setting preferred.
COMPENSATION | POSITION CLASSIFICATION
- LVN – $25hr / RN – $40
- Full Time | Contract Assignment