Full time Clinical Care Manager openings in the Sacramento, California area with a major healthcare company!
Starting ASAP!! Apply now with Luke H. at A-Line!
Summary: The Care Manager is responsible for providing care management services to beneficiaries with planned admissions to acute care hospitals, or to those transitioning from case management or disease management programs. Systematically identifies and addresses fragmented care for patients with acute, real-time needs and tailors’ interventions and services to fill gaps and produce optimal clinical outcomes cost-effectively.
HOURS: 40 hours per week - Monday to Friday - 8:00AM - 5:00PM
Required Education & Experience
- MINIMUM EXPERIENCE WITHIN MANAGE CARE= at least 1 year as a case manager within a manage care plan
- Graduate of Nursing program, RNs only- need experience with Medi-Cal population
- 2 + years of clinical experience in acute care setting-must be able to work with members w/chronic physical health conditions in addition to having mental health challenges
- Associate or Bachelor’s in nursing highly preferred
- Knowledge of UM principles and healthcare managed care, experience with medical decision support tools and government sponsored managed care programs
- Telephonic only. Will have a list of cases that they have to call on per day, twice a week they will get new cases to open up and do an assessment on the member and complete a care plan for the member, complete clinical rounds biweekly, CM monthly meeting
- Majority of day-outreach calls, calling physicians’ office, finding providers in/out of network that will take members, follow up calls, have to do motivational interviewing to get members on board with case management, teach member how to advocate for their goals, identifying root causes
- Pre-Admission Counseling Contacts patients with upcoming hospital admissions and discusses expectations.
- Assesses patients condition to understand illness or injury and evaluate ability to follow treatment plan.
- Advises patients of probable length of stay and helps anticipate and arrange for services at discharge.
- Admission Care Works with physicians and hospitals to enforce treatment plans and orders.
- Ensures patient receives specialty care and tests as ordered.
- Contacts medical team members to discuss patients course of progress and needs.
- Arranges for and coordinates health care team services, avoiding duplication and conserving benefit dollars.
- Evaluates need for and authorizes equipment, supplies, services. Identifies problems and acts to anticipate and avoid complications.
- Instructs patient and family in proper care and refers patient back to physician or other health care team members as needed.
- Identifies plateaus, improvements, regressions and depressions, and counsels accordingly.
- Confers with physician to clarify diagnosis, prognosis, therapies, daily living activities, and to share information.
- Authorizes recommended modalities of treatment. Investigates and suggests alternatives appropriately.
- Documents case summary in Transitional Care Plan and shares appropriately with beneficiaries and providers.
- Facilitates beneficiary transfers among regions and collaborates with military liaison to minimize disruption care or services.
- Identifies and submits modifications, requests for exceptions or special programs as warranted.
- Coordination of Financial Services Assesses patients benefit plan coverage and limitations.
- Negotiates cost-effective rates for provider services by contacting multiple providers and comparing specialty item costs, researching and identifying required equipment, and pursuing contracts accordingly.
- Suggests medically appropriate alternatives that accomplish treatment plan goals more cost effectively.
- Post Discharge Follow-up Contacts patients within 48 hours of discharge to ensure sufficient support for full recovery.
- Ensures proper receipt of equipment, home health and other services.
- Assesses compliance with medications and follow-up appointments.
- Assists patient in coordinating transportation and other basic needs, and in navigating the health care system effectively.
- Full benefits available after 90 days: Medical, Dental, Vision, Life, Short-term Disability
- 401k after 1 year of employment: With employer match and profit sharing
- GREAT Hours! Monday through Friday, 40 hours per week
- Competitive Pay Rate
Keywords: Data Entry, Healthcare, Admin Assistant, Call Center, Mail Order Medications, Insurance Verification, Pharmacy, Prior Authorization, Reimbursement Counselor, Medical Customer Service, Healthcare, Inbound Calls, Outbound Calls.