Utilization Care Manager Jobs in Reno, NV (NOW HIRING)

We are seeking a Care Manager - CA to join our team at Independent Living Systems (ILS). ILS, along with its affiliated health plans known as Florida Community Care and Florida Complete Care, is committed to promoting a higher quality of life and maximizing independence for all vulnerable populations.

About the Role:

The Care Manager in California plays a pivotal role in coordinating and managing comprehensive care plans for individuals requiring health and social support services. This position ensures that members receive personalized, effective, and timely care by collaborating with healthcare providers, social workers, and family members. The Care Manager acts as a liaison to facilitate communication among all parties involved, advocating for the client’s needs and preferences. They monitor client progress, adjust care plans as necessary, and ensure compliance with regulatory standards and organizational policies. Ultimately, the role aims to improve client outcomes, enhance quality of life, and optimize resource utilization within the care continuum.

Minimum Qualifications:

• Bachelor’s degree in social work, Psychology, Biology, Public Health, Nursing, Community Health, or Health related field or equivalent experience required.
• Requires at least 5 years of experience working with people who need assistance with complex health and social issues.
• Requires knowledge of and experience working with community agencies and programs.
• Requires experience with Medi-Cal eligibility guidelines, application, and renewal/redetermination process.
• Requires strong problem-solving and customer service skills.
• Must be a CA Resident and must reside in CA while employed.
• Current and valid California (CA) Driver’s License.
• Must use personal vehicle and current vehicle registration required.
• Proof of auto insurance required, must maintain CA minimum insurance coverage.
• BCLS CPR Certification required.

Preferred Qualifications:

• Master’s degree in Nursing, Social Work, Public Health, or Healthcare Administration.
• Certified Case Manager (CCM) credential or equivalent certification.
• Experience working with diverse populations including elderly, disabled, or chronically ill clients.
• Bilingual abilities, particularly in Spanish or other commonly spoken languages in California.

Responsibilities:

• Develop and manage Individualized Care Plans for members in assigned caseload and provide consistent and effective care coordination as indicated by the Care Plan.
• Assess psychosocial and social determinants of health needs for high-risk members and document assessment results or augment available information in appropriate systems
• Consult with or refer members to licensed staff (social worker, nurse case manager etc.) as required based on member social, health risk and medical complexity.
• Establish relationships and partner with community resources, health plans and providers by participating in community engagement activities with local agencies e.g. faith-based organizations, community centers, government agencies, parks, recreation centers and schools
• Assist members with problem solving barriers to high complexity health conditions by identifying, locating, connecting to and navigating needed community and medical system services, including visiting members at their homes, accompanying members to medical appointments and assisting members with completing forms to access needed services
• Actively engage, build rapport, establish trusting relationships and facilitate collaborative communication with members and member family support systems
• Identifies social determinants of health concerns/ gaps, develops and documents a plan to address complex social and health disparities
• Documents member updates and progress notes in appropriate systems, submits timely reports, and provides recommendations for improved member outcomes tracking
• Identifies gaps in community resources and medical systems, makes recommendations to close gaps and implements new services or solutions to close identified gaps