Remote Optum Rn Jobs in Sacramento, CA (NOW HIRING)

Case Manager – RN / Clinical Liaison

Hours: 9 am to 530pm
Start date: ASAP
Pay rate: $65,000 to $70,000
Position: Remote – Home Base

Clinical Liaison / Case Manager Position: 

• Work closely with the Director of Nursing and Executive Director of Case Management and other Clinicians
• Assist with managing the day-to-day operations of the Assisted Living Waiver Program (ALW) and other Medi-Cal specialty programs as determined.
• Coordinate with the facility, members, and their families on current health status, resource utilization, past and present treatment plans and services, prognosis, short-term and long-term goals, treatment, and provider options.
• Ensure urgency with SNF/Hospital transitions/placements.
• Determination of eligibility for enrollment in the assisted living waiver program and other Medi-Cal-funded programs
• Conducting an initial and ongoing assessment using the ALW Assessment Tool
• Determining each beneficiary’s level of care (i.e., tier changes)
• Developing the Individualized Service Plan (ISP)
• Monitor service delivery by the RCFE/ALF and other providers.
• Maintain progress notes and case records for each enrolled beneficiary.
• Receiving, reviewing, and responding to concerns/complaints from clients, families, or POA and forwarding all concerns/complaints to DHCS
• Reporting all signs of abuse or neglect to DHCS and the Ombudsman (if abuse or neglect occurs in an RCFE) or DHCS and APS (if abuse or neglect occurs).
• Facilitate member access to community-based services.
• Monitor referrals to community-based organizations, medical care, and other services to support the members’ overall care management plan.
• Actively participate in integrated team care management rounds
• Identify related risk management quality concerns and report these scenarios to the appropriate resources.
• Oversee all case managers' and social workers' cases for accuracy
• Work closely with compliance on monthly file audits
• Work directly with clients/family members/facilities
• Worked closely with Star Nursing field Case Managers (CM)
• Coordinate with facility, members, and family on long-term goals, resource utilization, discharge, transition, and admissions to an approved facility.
• Identify related risk management quality concerns and report these scenarios to the appropriate resources.
• Enter, review, and maintain assessments, authorizations, and pertinent clinical information into MedCompass management systems.
• Responsible for submitting documentation to vendors
• Review all initial tier changes, changes in CCAs, or any other submission to DHCS to ensure 100% file compliance before submitting to DHCS.
• Participate in case management committees and work on special projects related to case management as needed.

Staff Development

•  Participate in developing, planning, conducting, and scheduling in-service/online training classes.
• Participate in company committees and act as a resource to junior social workers.

Care Plan and Assessment Functions

•  Review care plans routinely to ensure that appropriate care is being received.
• Ensure that monthly visit notes reflect that the care plan is being followed by the facility and caregivers.
• Review patient care plans for appropriate goals, problems, approaches, and revisions based on patient-centered needs.

Patient Rights

•  Maintain the confidentiality of all patient care information.
• Monitor care to ensure that all patients are treated fairly, and with kindness, dignity, and respect.
• Report and investigate all allegations of patient abuse and/or misappropriation of property.

Working Conditions

• Works in office area(s) as well as in care homes and larger assisted living facilities
• Sits, stands, bends, lifts, and moves intermittently during working hours.
• Is subject to frequent interruptions.
• Is involved with patients, personnel, visitors, government agencies/personnel, etc., under all conditions and circumstances
• Is subject to hostile and emotionally upset patients, family members, personnel, and visitors
• Communicates with the medical staff, nursing personnel, and other department supervisors.
• Attends and participates in continuing educational program
• Maintains a liaison with the patients, their families, support departments, etc., to adequately plan for the patient's needs.

Qualifications:

• Previous experience in social work, counseling, or other related fields
• Compassionate and caring demeanor
• Ability to build rapport with clients
• Strong leadership qualities
• Excellent written and verbal communication skills

Education/ Experience

• Bachelor’s or master’s degree in nursing, social work, Psychology, counseling, rehabilitation, gerontology, or sociology.
• Must possess, as a minimum, 1 year of recent related work experience
• Experience working with government programs is a plus

Specific Requirements

•  Must possess a current, unencumbered, active license to practice as a Registered Nurse in the State of California
• Strong knowledge and understanding of Title 2
• Familiarity with medical software, microsoft office suites/excel/word
• Must possess the ability to make independent decisions when circumstances warrant such action.
• Must possess the ability to deal tactfully with personnel, patients, family members, visitors, government agencies/personnel, and the general public.
• Must be knowledgeable of nursing and medical practices and procedures, as well as laws, regulations, and guidelines that pertain to community health care.
• Must possess leadership and supervisory ability and the willingness to work harmoniously with professional and non-professional personnel.
• Must have patience, tact, a cheerful disposition, and enthusiasm, as well as the willingness to handle difficult patients.

Additional Information:

The Clinical Liaison/Case Manager is responsible for educating Medi-Cal Members and their families about the requirements of the ALWP.  The Assisted Living Waiver program is designed to assist low-income seniors or adults aged 21 with a disability, providing an alternative to living at home or in a skilled nursing facility.  By providing funding to move into the RCFE/ALF care setting.  The Clinical Liaison/Case Manager is responsible for multiple tasks throughout the workday.  This position requires a licensed RN with a minimum of one year of current experience in management, long-term care, skilled nursing, sub-acute care, post-acute care, assisted living, and hospital settings.  Experience working with discharge planners and social services departments would be helpful.  This Clinical Liaison/Case Manager will work directly with case managers and discharge planners to process Assisted Living Waiver referrals, Health plans, and other specialty programs in a timely and efficient manner.  Must have experience with a high-volume workload.  This is a work-from-home position with the flexibility to do monthly visits with a caseload of residents residing in ALF/RCFEs. 

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