- Identifies potential candidates effectively by utilizing various data sources, such as daily inpatient census, internal data, self-referrals, provider referrals, and utilization management staff
- Assess and manage member needs such as complex medical, psychosocial, cognitive and functional conditions.
- Assist with member Health Risk Assessment (HRA) surveys to administer and contact as needed. Identify early risk factors and conduct ongoing phone assessments when necessary.
- Review members’ HRA survey responses for both Commercial and the Senior Select (Special Needs Plan) population.
- Develop a comprehensive care plan with appropriate interventions consistent with policy guidelines and Medicare/Medicaid requirements within the care management system. Gather input from the member and/or responsible parties in the development of the care plan.
- Modifies the plan of care through monitoring and re-evaluation to accommodate changes in treatment or progress for assigned members.
- Document all activities in the care management system to allow for continuity of care.
- Performs post discharge follow up, case management, and disease management duties through promoting healthy lifestyles, closing gaps in care, reducing unnecessary ER utilization and hospital readmissions. Provide members with appropriate education to enhance their knowledge related to health or lifestyle management.
- Identifies for medically complex members and consult with others of the interdisciplinary team. Work collaboratively with others of the interdisciplinary team in assessing, planning, and providing services to members.
- Assist in coordinating communication between doctor’s office, clinics, hospitals, member/families, home health agencies, vendors, and staff.
- Utilizes evidence-based guidelines such as MCG and other tools such as HealthWise.
- Maintain a caseload panel through prompt identification and response to cases appropriate for level of care changes including but not limited to discharge or transfer activities.
- Monitors & reports outcomes of the member weekly/ monthly as requested.
- Accepts and performs other duties as assigned.
- Current RN license
- At least one year of Case Management experience preferred
- Bilingual (Cantonese & English)
- Current BLS card per contract requirements
- Current TB or Chest x-ray (if applicable)
- Ability to effectively elicit/provide information to and from appropriate individuals (including, but not limited to, supervisors, co-workers, clients) via strong communication skills; proficiency in the English language may be required
- Computer proficiency required
- Competitive pay & weekly paychecks
- Health, dental, vision, and life insurance
- 401(k) savings plan
- Awards and recognition programs
"Pursuant to the San Francisco Fair Chance Initiative, Maxim Healthcare will consider for employment qualified applicants with arrest and conviction records"
in the lives of our employees, caregivers and patients for 30 years. We offer services including
home healthcare, behavioral care, healthcare staffing, personal caregiving, and population
health and wellness. Our commitment to compassionate patient care and staffing world-class
professionals has paved the way for many rewarding career opportunities in the healthcare