Remote Utilization Management Jobs in Rancho Cucamonga, CA

The Lead Care Manager (LVN) works in collaboration and continuous partnership with chronically ill or “high-risk” members and their family/caregiver(s), clinic/hospital/specialty providers and staff, and community resources in a team approach to: 
•    Coordinate with those individuals and/or entities to ensure a seamless experience for the member and non-duplication of services
•    Engage eligible members
•    Oversee provision of ECM services and implementation of the care plan.
•    Offer services where the member lives, seeks care, or finds most easily accessible and within the Plan guidelines
•    Connect member to other social services and supports the member may need, including transportation
•    Advocate on behalf of members with health care professionals
•    Use motivational interviewing, trauma-informed care, and harm-reduction approaches
•    Coordinate with hospital staff on discharge plans
•    Accompany member to office visits, as needed and according to the Plan guidelines
•    Monitor treatment adherence (including medication)
•    Provide health promotion and self-management training
•    Promote timely access to appropriate care
•    Increase utilization of preventative care
•    Reduce emergency room utilization and hospital readmissions
•    Increase comprehension through culturally and linguistically appropriate education
•    Create and promote adherence to a care plan, developed in coordination with the member, primary care provider, and family/caregiver(s)
•    Increase continuity of care by managing relationships with tertiary care providers, transitions-in-care, and referrals
•    Increase members’ ability for self-management and shared decision-making
•    Connecting members to relevant community resources to enhance member health and well-being, increase member satisfaction, and reduce health care costs
•    Connect and follow up with members, family/caregiver(s), providers, and community resources via face-to-face, secure email, phone calls, text messages, and other communications
•    Serve as the contact point, advocate, and informational resource for members, care team, family/caregiver(s), payers, and community resources
•    Work with members to plan and monitor care
•    Assess member’s unmet health and social needs
•    Develop a care plan with the member, family/caregiver(s), and providers (emergency plan, health management plan, medical summary, and ongoing action plan, as appropriate)
•    Monitor adherence to care plans, evaluate effectiveness, monitor member progress on time, and facilitate changes as needed
•    Create ongoing processes for members and family/caregiver(s) to determine and request the level of care coordination support they desire at any given time
•    Facilitate member access to appropriate medical and specialty providers
•    Educate members and family/caregiver(s) about relevant community resources
•    Facilitate and attend meetings between members, family/caregiver(s), care team, payers, and community resources, as needed
•    Cultivate and support primary care and specialty provider co-management with timely communication, inquiry, follow-up, and integration of information into the care plan regarding transitions-in-care and referrals
•    Assist with the identification of “high-risk” members (the chronically ill and those with special health care needs), and add these to the member registry (or flag in EHR)
•    Attend all Lead Care Manager training courses/webinars and meetings
•    Provide feedback for the improvement of the ECM Program
•    Offer services where the Member lives, seeks care, or finds most easily accessible and within Medi-Cal Managed Care health plans (MCP) guidelines
•    Engage eligible Members
•    Arrange transportation
•    Call Member to facilitate Member visit with the ECM Lead Care Manager 

QUALIFICATION REQUIREMENTS:
To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements below represent the required knowledge, skill, and/or ability. Reasonable accommodations may enable individuals with disabilities to perform essential functions.
•    Although this role is remote, there will be times when you will be required to report to our satellite office (or a specified, remote location) to work, to attend meetings, or other training
•    Required to have and maintain your own personal vehicle for this role

     You will receive a monthly mileage reimbursement per applicable state/federal laws
•    You must have a valid driver’s license, proof of insurance, and a good driving record
•    You will visit hospitals and visit patients at their homes, as needed
•    Must present proof of Negative TB Test & CPR Certification before hire date
•    Must complete a Live Scan Fingerprint/Background check

 EDUCATION AND/OR EXPERIENCE:
•    An associate’s degree, or bachelor's degree in health science or any related health care degree is preferred 
•    Social Worker, LVN, or experience in case management is a PLUS!

SKILL AND KNOWLEDGE REQUIREMENTS:
•    Excellent analytical, problem-solving, and prioritization skills
•    Excellent verbal and written communication skills
•    High-level of interpersonal skills. Able to work collaboratively and tactfully with multi-disciplinary and diverse teams that may include employees, customers, and physicians
•    Effective computer skills, particularly Microsoft Office, Excel, PowerPoint, Word, etc.
•    Work independently to complete assigned tasks
•    Team building
•    Project Management
•    Change Management
•    Quality and Process improvement tools
•    Project Execution
•    MUST consistently achieve a minimum daily expectation of 30 schedules/day 

BENEFITS:
•    Medical/Dental/Vision - available after successful completion of the 90-day probationary period
•    Free $100K Life Insurance
•    401k eligibility after 1,000 hours of service
•    Starting hourly range for this role is $30-$32 per hour