Complex Case Manager Jobs in Fremont, CA (NOW HIRING)

Burlingame, CA 94010

Salary Range $143,098.80 - $165,048.00 Salary

Summary Of Position:

Nurse Case Managers are licensed nursing professionals responsible for coordinating continuum of care and discharge planning activities, developing individualized person-centered care plans and goals, and facilitating case conferences among all service providers for a caseload of assigned patients.

Nurse Case Managers act as consultants to the clinical team, service lines, and other departments regarding patient assessment and patient care, and participate in program development and quality improvement initiatives in their role, by applying guidelines and collaborating with multidisciplinary teams. Case Managers influence and direct the delivery and quality of patient care. The objectives are to facilitate timely discharges, prompt and efficient use of resources, achievement of expected outcomes, collaborative practice, coordination of care across the continuum, and performance/quality improvement activities that lead to optimal patient outcomes.

Nurse Case Managers differ from other roles in professional nursing/health care practice in that they do not provide direct medical care to patients; rather, a Nurse Case Manager will be assigned to specific patients to ensure that the medical services and treatments are accomplished in the most financially and clinically efficient manner.

• Applies professional clinical skills and expertise in the assessment, planning, implementation, and coordination of necessary healthcare services.
• Develops and manages individualized plan of care to assure consistent, timely, and appropriate care is provided in a patient-focused manner; collects data, assesses needs, identifies problems and options, plans appropriately, sets goals, monitors and evaluates progress.
• Provides an interdisciplinary process in which healthcare team members collaborate with patients and their families to support quality care and to ensure that patient's care is continuous and integrated among all service providers.
• Provides disease management to patients who have certain diseases such as end stage renal disease, cancer, and palliative care.
• Manages patients in different case management programs such as the Chronic Care Management, Enhanced Care Management, Community Support, and Complex Case Management programs.
• Facilitates timely implementation of hospital discharge plans in collaboration with other interdisciplinary team members; arranges follow-up care as appropriate.
• Performs home visits to patients meeting complex case management criteria; performs medication reconciliation within the nursing scope of practice. Accompanies patients to provider visits as needed. Meets patients at their home or homeless patients in public areas as needed to facilitate enhanced care coordination services.
• Collaborates with MSO Utilization Management team and PCPs to ensure resource utilization is appropriate; plans and implements strategies to reduce resource consumption and achieve positive patient outcomes.
• Identifies community resources and assists patients in applying for the needed services.
• Participates in internal and external meetings and presents relevant information to designated committee.
• Makes complex clinical decisions regarding medical care; involves medical directors and providers to solve the complex issues.
• Utilizes multiple systems to maintain documentation of case management activities; collects, analyzes and reports on data for utilization, quality improvement, compliance, and other areas as assigned.
• Responsible for the development of staff training and orientation programs to assure homogeneous execution of job standards by each team member.
• Responsible for providing training to new NCM and Care Coordinators in the Case Management team to guide them in accurately completing their work and to ensure complete understanding of the NEMS CC/CM program.
• Reviews and updates case management program descriptions and policies and procedures to improve case management outcome and to meet State, Federal, and health plan requirements.
• Monitors and trends activities that affect case management, data collection, analysis and reports; formulates a plan to address deficiencies identified.
• Performs other job duties as required by manager/supervisor.

• Valid California Registered Nurse license.
• Minimum 3 years managed healthcare case management experience with the ability to manage a minimum of 50 clients at any given time.
• Experience working with individuals with multiple diagnoses who may have multiple barriers (i.e., mental illness, substance use, and chronic medical conditions).
• Working knowledge and use of Trauma Informed, Harm Reduction and Person-Centered language and principles.
• Knowledge of managed care and community resources and cultural needs.
• Demonstrate willingness to make decisions within RN's clinical scope of practice; exhibit sound, accurate, and ethical judgment.
• Ability to engage and work collaboratively with others, including patients, patient's families, clinical team members, clinical supervisors, and community resources.
• Ability to provide detailed, concise note/documentation of works within workflow turn-around timelines.
• Basic medical knowledge, including the ability to observe safety and security procedures, and recognize trauma symptoms and behaviors.
• Able to spend 20-40 minutes at a time with patient in the community, including at clinics, specialist offices, hospitals, community-based organizations, or patient's home which may be in understaffed/remote areas, in the presence of pets, or members/family members that are tobacco users.
• Valid Driver License and ability to maintain required.
• Time management and prioritization skills are vital.
• Current documentation of Basic Life Support is required.

• Must be able to fluently speak, read and write English.
• Fluent in Chinese (Cantonese and Mandarin) required.
• Fluent in other languages is an asset.

• This is an FLSA exempt position.
• This is not an OSHA high-risk position.
• This is a Full Time position.

NEMS is proud to be an Equal Opportunity Employer welcoming diversity in our workforce. Pursuant to the San Francisco Fair Chance Ordinance, we will consider for employment qualified applicants with arrest and conviction records.

NEMS BENEFITS: Competitive benefits, including free medical, dental and vision insurance for employee, spouse and/or children; and company contribution to 401(k).