Medical Case Manager, RN - Impresiv Health
Orange, CA 92868
About the Job
Title: Medical Case Manager, RN
Duration: up to 6 months
Compensation: $43.66-$69.86/hour
Description: Case Management is an advanced specialty collaborative practice, responsible for providing ongoing case management services for our Client's members. The Medical Case Manager will facilitate communication and coordination among all participants of the health care team and the members to ensure the services provided promote quality and cost-effective outcomes. The incumbent will be responsible for providing intensive case management, which includes assessment, planning, implementation, coordination, monitoring, and evaluation of the member's needs.
What You Will Do:
You Will Be Successful If:
What You Will Bring:
About Impresiv Health:
Impresiv Health is a healthcare consulting partner specializing in clinical & operations management, enterprise project management, professional services, and software consulting services. We help our clients increase operational efficiency by delivering innovative solutions to solve their most complex business challenges.
Our approach is and has always been simple. First, think and act like the customers who need us, and most importantly, deliver what larger organizations cannot do provide tangible results that add immediate value, at a rate that cannot be beaten. Your success matters, and we know it.
That's Impresiv!
Duration: up to 6 months
Compensation: $43.66-$69.86/hour
Description: Case Management is an advanced specialty collaborative practice, responsible for providing ongoing case management services for our Client's members. The Medical Case Manager will facilitate communication and coordination among all participants of the health care team and the members to ensure the services provided promote quality and cost-effective outcomes. The incumbent will be responsible for providing intensive case management, which includes assessment, planning, implementation, coordination, monitoring, and evaluation of the member's needs.
What You Will Do:
- Participates in a mission driven culture of high-quality performance, with a member focus on customer service, consistency, dignity, and accountability.
- Assists the team in carrying out department responsibilities and collaborates with others to support short and long-term goals/priorities for the department.
- Performs comprehensive, disease specific, clinical assessments of all identified cases which includes, but is not limited to, assessment of:
- Member's physical, functional, social and psychological status
- Member's cultural and linguistic needs
- Caregiver resources and available benefits
- Develops and implements a member's specific care plan which includes prioritized goals.
- Schedules follow-ups to assess progress towards goals and identifies barriers to meeting goals.
- Communicates with member's physicians, specialists, community agencies and vendors to ensure coordination of services.
- Follows company protocol for documenting all case interventions.
- Facilitates Interdisciplinary team meetings as applicable.
- Facilitates referrals to behavioral health/substance use disorder services and identifies and makes referrals to LTSS department, community supports and community resources.
- Collaborates with interdepartmental staff in case resolution as needed.
- Identifies cases needing manager, director or medical director to review or input, routes accordingly and closes cases according to procedures and guidelines in a timely manner.
- Prepares and maintains appropriate documentation of patient care and progress within the care plan.
- Advocates in the member's best interest for necessary funding, treatment alternatives, timelines and coordination of care and frequent evaluations of progress and goals .
- Completes other projects and duties as assigned.
You Will Be Successful If:
- You possess the ability to:
- Maintain and ensure confidentiality of patient information.
- Interview members to determine the client's strengths, problems prognosis, functional status, goals and need for specific services/resources and to establish prioritized goal.
- Develop a plan, when indicated through multi-disciplinary collaboration which identifies options and goals.
- Access and interpret reports and data.
- Perform tasks independently.
- Establish and maintain effective working relationships with CalOptima Health's leadership and staff, other programs, agencies and the population served.
- Communicate clearly and concisely, both orally and in writing
- Utilize computer and appropriate software (e.g., Microsoft Office: Excel, Outlook, PowerPoint, Word) and job-specific applications/systems to produce correspondence, charts, spreadsheets and/or other information applicable to the position assignment.
- You have knowledge of:
- Guidelines and regulations relevant to case management and utilization management.
- Confidentiality and the legal and ethical issues pertaining to case management.
- National Committee for Quality Assurance (NCQA) Standards.
- Complex case management.
- Community resources.
- Charting practices and guidelines.
- Available medical treatments and resources.
- Principles and practices of health care, health care systems and medical administration.
What You Will Bring:
- Associate's degree in nursing required, Bachelor of Science in Nursing Degree preferred
- Current and unrestricted RN license in the state of CA
- 3+ years of clinical nursing experience
- 3+ years of experience as a Case Manager in a Health Plan/MCO
- CCM certification preferred
- Bilingual in English and one of the following defined threshold languages (Arabic, Chinese, Farsi, Korean, Spanish, Vietnamese) preferred
About Impresiv Health:
Impresiv Health is a healthcare consulting partner specializing in clinical & operations management, enterprise project management, professional services, and software consulting services. We help our clients increase operational efficiency by delivering innovative solutions to solve their most complex business challenges.
Our approach is and has always been simple. First, think and act like the customers who need us, and most importantly, deliver what larger organizations cannot do provide tangible results that add immediate value, at a rate that cannot be beaten. Your success matters, and we know it.
That's Impresiv!
Source : Impresiv Health
