RN; Care Manager

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  • 17-00237
  • Full Time/Contract
  • Case Management
  • Rancho Cucammonga, CA
Job Description
JOB TITLE
RN; CARE MANAGER

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.

  • 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. Act as a Member advocate
  4. Serve as a liaison between Member, caregivers, and providers
  5. Educate and support Members/caregivers with meeting ICP goals
  • 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, Disabilities, Behavioral Health, and community resources.
  • Responsible for any other duties as required to ensure successful care management processes and Member outcomes.
  • Responsible for any other duties as required to ensure successful care management processes and Member outcomes.
  • Any other duties as required to ensure Health Plan operations are successful.
  • Ensure the privacy and security of PHI (Protected Health Information) as outlined in policies and procedures relating to HIPAA compliance.

SKILLS & QUALIFICATIONS
Possession of a valid RN or issued by the State of California Possession of a valid State of California driver’s license.

  • 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.

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