Care Manager RN / LVN

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  • 18-00236
  • Full Time/Contract
  • Utilization Management
  • Rancho Cucamonga, CA
Job Description
CLIENT COMPANY OVERVIEW
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.

JOB TITLE
CARE MANAGER – RN / LVN

DESCRIPTION
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:
  1. Conduct clinical assessment and medication reconciliation.
  2. Develop, implement, and evaluate individualized care plans (ICP)
  3. Review and revise contributions to assessment information and care planning from care team members (i.e. LVN Care Manager, Care Coordinator) as appropriate
  4. Act as a Member advocate
  5. Serve as a liaison between Member, caregivers, and providers
  6. Educate and support Members/caregivers with meeting ICP goals
  7. 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

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