- Full Time/Contract
- Rancho Cucamonga, CA
Care manager, RN
Under the general supervision of the Manager and direct supervision of the Care Management Supervisor, this position is responsible for working effectively with Integrated Care Team to provide high quality, effective care management to health plan members. Care management is broadly defined, and can include outreach and engagement to members, engaging members in skilled therapeutic interactions to promote health behaviors, other behavioral health interventions within scope, coordination of care, resource linkages, working with other professionals and organizations in the community to ensure quality of care for members, seamless transitions of care, and facilitating the right care and the right time for the member. This position works collaboratively with members of the Integrated Care Team, members and families, and other professionals, in addition to working collaboratively with the designated health care organization's (HCO) medical team. This position, like all positions is expected to model whole health principles of relationship-based care, as well engage in promoting education and understanding of physical health and healthy behaviors to those and in the community.
- Responsible for primarily working with a caseload of Members with medical needs.
2. Responsible for utilizing brief medical interventions as necessary to improve the Member's ability to manage their own health.
3. Provide formal and informal training and support for Team Members on medical conditions, including treatments and evidence-base for treatment.
4. Responsible for assisting Members with care coordination needs, including, but not limited to, the following:
a. Conduct comprehensive, holistic assessment according to the scope of the RN license
b. Assimilate assessment information into developing an individualized care plan (ICP)
c. Communicate ICP with Member, approved family or caregiver and other Members of the care team
d. Lead interdisciplinary care team meetings to share information, update and inform care plan
e. Coordinate with internal and external health partners to support Members comprehensive care needs
f. Participate and lead care transition planning.
5. Review and revise contributions to assessment information and care planning from care team members (i.e. LVN Care Manager, Care Coordinator) as appropriate.
6. Model the highest ethical behavior in relationships with co-workers, supervisors, Members, Providers, and colleagues in the community.
7. Responsible for promoting a collaborative and effective working environment within the Team by engaging in evidenced-based communication strategies (such as Motivational Interviewing) when discussing responsibility/sharing of tasks, effectively resolving conflicts as they arise, and collaborating on Member case discussions.
8. Responsible for building and maintaining a positive working relationship with Providers, including, but not limited to, communication via in-person, over the phone, and through digital means such as email and fax.
9. Responsible for engaging with Members, both in-person and on the phone, in a manner that utilizes evidence-based approaches (such as Motivational Interviewing) that promotes collaboration between the Member and his or her medical/behavioral team, as well as to increase the Member's sense of control over their whole health.
10. Model commitment to continuous quality improvement by engaging in quality improvement initiatives and projects, such as by identifying and addressing HEDIS gaps, and by identifying, developing, and testing new practices for improving Member health outcomes.
11. Assists with the coordination of medical and behavioral health access issues with PCP offices, specialists, and ancillary services.
12. Ensures documentation is accurate and in compliance with regulatory requirements and accreditation standards.
13. Participates in Health Plan staff meetings, trainings, committee meetings, or other activities as needed or as directed by Leadership Team Members.
- Two (2) or more years of care management experience in a health care delivery setting preferred.
- Experience in a Managed Care (HMO, IPA) or in acute facility (i.e. hospital) care management preferred.
- Possession of a valid, unrestricted RN license issued by the State of California