- Direct Placement
- Case Management
- Torrance, CA
Ambulatory Care Manager – RN
The Ambulatory Care Manager RN (ACM) coordinates and monitors the health needs of members, such as pain, symptom management, behavioral health, DME’s, home health, assistance with daily living, and/or community resources. The Care Manager works closely with members, caregivers, family members, physicians, hospital care managers, and ancillary service providers to achieve the member’s maximum functional potential. This position provides on-going support through comprehensive assessment and care planning. The care manager ensures member’s cases are in compliance with regulatory guidelines.
- Conducts a comprehensive assessment of member’s health status, activities of daily living, psychosocial, cultural and linguistic needs, available benefits and resources, caregiver resources, life planning activities and community resources via phone or in-person.
- Creates an individualized care plan that meets member needs includes prioritized goals, development of schedules for follow-up, communication with member of self-management plan.
- Documents member’s assessments, care plans, goals and interventions in electronic medical management system according to NCQA standards.
- Evaluates member’s progress against care plans, goals, interventions and modifications as needed.
- Communicates and coordinate services with member and member’s care team, such as Primary Care Physician (PCP), specialists, medical providers, and ancillary providers as necessary to meet member’s medical and psychosocial needs.
- Facilitate member access to behavioral health, social services and community based services as needed.
- Monitors changes in member’s health status and updates documentation including care plan, care plan goals and modifications in care plan as needed.
- Actively participate in Interdisciplinary Care Team Meetings.
- Performs in-home assessments as needed
- Performs other related duties, as requested
- Register Nurse with unrestricted CA license
- Thorough knowledge in case management
- Experience in acute care settings preferred
- Ability to establish and maintain rapport with members, families, and caregivers
- Ability to establish and maintain professional relationships and communications with the care team, such as physicians, social workers, Inpatient Case Managers, and ancillary providers etc.
- Excellent verbal and written communication skills
- Knowledge and experience in navigating health plan and community resources.
- Knowledge of health plan and regulatory guidelines
- Commensurate with experience
- Full Time / Direct Hire