POSITION PURPOSE
The Care Manager is responsible for working directly with the Plan, IPA medical groups, providers, hospitals, community agencies, Members/caregivers, and other entities supporting clientcare to ensure coordinated, continuous care and serve as a resource person to these facilities. The RN Care Manager supports the care team, finalizes the care management assessment and Individualized Care Plan (ICP).
Responsibilities
- Responsiblefor serving as a resource for Clients and Providers for caremanagement and continuity of care.
- Responsiblefor assessing clients for appropriate care management needs including:
- Conductinga clinical assessment and medication reconciliation.
- Develop,implement, and evaluate Individualized Care Plans (ICP)
- Actas a Member advocate
- Serveas a liaison between clients, caregivers, and providers
- Educateand support clients/caregivers with meeting ICP goals
- Identifyneed for Interdisciplinary Care Team (ICT), organize the participants tobe included and ensure facilitation and documentation of the ICT.
3.Review and revise contributions to assessment information and care planning from care team members (i.e. LVN
Care Manager, Care Coordinator) as appropriate.
4.Assist with referrals for clients that are eligible for carve out programs such as CCS, multi-organ transplant,
etc.
5.Assist clients with immediate needs with regard to access, referrals and authorizations.
6.Assist clients with resources such as LTSS, Independent Living and Diversity Services, Behavioral Health, and
Community Resources.
7.Responsible for any other duties as required ensuring successful care management processes and Member
outcomes using critical thinking and innovative techniques to engage and retain Members in the CM program.
8.Any other duties as required or assigned to ensure Health Plan operations are successful.
Requirements
Requirements
Education/License:
Valid, unrestricted RN license issued by theState of CaliforniaPossession of a valid State of Californiadriver's license.
Experience:
Minimum 2 years clinical experience in anacute care facility, skilled nursing facility, home health or clinic setting.Two( 2) or more years of care management experience in a health caredelivery setting preferred.Experience in a Managed Care (HMO, IPA) orin acute facility (i.e. hospital) care management preferred.
Benefits
Excellent benefits and total incentives.