RN, Care/Case Management (Social Work)

  • Location
    Camarillo, California
  • Job type
    Direct Hire
  • Category
    Medical & Science - Nursing

RN, Care/Case Management (Social Work)

Adecco Medical & Science is seeking a RN, Care/Case Management (Social Work) candidate for a direct hire position at the top health plan organization in beautiful Camarillo, Ca (Ventura County)!

The care management team supports the company mission to improve the health of the members through the provision of best possible quality care and services. As defined by the Case Management Society of America (CMSA 2016 Standards of Care):
“Professional case management today fosters the careful shepherding of health care dollars while maintaining a primary and consistent focus on quality of care, safe transitions, timely access
to and availability of services, and most importantly client self-determination and provision of client-centered and culturally-relevant care. These without a doubt enhance the health of individuals and communities. They also demand a professional case manager who (a) is academically prepared in a health or human services discipline; (b) possesses an unrestricted license or certification as required by the jurisdiction of employment; (c) is able to function independently and according to the scope of practice of the background health discipline; (d) demonstrates current knowledge, skills, and competence to effectively provide holistic and client- centered care; and (e) acts in a supervisory capacity of other personnel who are involved in the client"s care but unable to function independently due to limitations of license and/or education.”

ESSENTIAL FUNCTIONS Case Management is a collaborative process of assessment, planning, facilitation, care coordination, evaluation and advocacy for options and services to meet an individual"s and family"s comprehensive health needs through communication and available resources to promote patient safety, quality of care, and cost effective out- comes
Reasonable Accommodations Statement
To accomplish this job successfully, an individual must be able to perform, with or without reasonable accommodation, each essential function satisfactorily. Reasonable accommodations may be made to help enable qualified individuals with disabilities to perform the essential functions.

Essential Functions Statement(s)

• Conducting an assessment of the client's health, physical, functional, behavioral, psychological, and social needs, including health literacy status and deficits, self-management abilities and engagement in taking care of own health, availability of psychosocial support systems including family caregivers, and socioeconomic background. The assessment leads to the development and implementation of a client-specific case management plan of care in collaboration with the client and family or family caregiver, and other essential health care professionals.
• Identifying target care goals in collaboration with the client, client's family or family caregiver, and other members of the health care team. Securing client's agreement on the target goals and desired outcomes.
• Planning the care interventions and needed resources with the client, family or family caregiver, the primary care provider, other health care professionals, the payer, and the community-based agents, to maximize the client's health care responses, quality, safety, cost-effective outcomes, and optimal care experience
• Facilitating communication and coordination among members of the interprofessional health care team, and involving the client in the decision-making process in order to minimize fragmentation in the services provided and prevent the risk for unsafe care and suboptimal outcomes
• Collaborating with other health care professionals and support service providers across care settings, levels of care, and profession- al disciplines, with special attention to safe transitions of care.
• Coordinating care interventions, referrals to specialty providers and community-based support services, consults, and resources across involved health providers and care settings.
• Communicating on an ongoing basis with the client, client's family or family caregiver, other involved health care professionals and support service providers, and assuring that all are well-informed and current on the case management plan of care and services
• Educating the client, the family or family caregiver, and members of the interprofessional health care team about treatment options, community resources, health insurance benefits, psychosocial and financial concerns, and case management services, in order to make timely and informed care-related decisions.
• Counseling and empowering the client to problem-solve by exploring options of care, when available, and alternative plans, when necessary, to achieve desired outcomes
• Coordinating indicated notifications for and pre-authorizations of services, medical necessity reviews, and concurrent or retrospective communications, based on payer's requirements and utilization management procedures
• Ensuring the appropriate allocation, use, and coordination of health care services and resources while striving to improve safety and quality of care, and maintain cost effectiveness on a case-by-case basis
• Identifying barriers to care and client's engagement in own health; addressing these barriers to prevent suboptimal care outcomes
• Assisting the client in the safe transitioning of care to the next most appropriate level, setting, and/or provider
• Striving to promote client self-advocacy, independence, and self-determination, and the provision of client-centered and culturally appropriate care.

• Engaging in performance improvement activities with the goal of improving client's access to timely care and services, and enhancing the achievement of target goals and desired outcomes.

Competency Statement(s)

• Accountability - Ability to accept responsibility and account for his/her actions.
• Customer Oriented - Ability to take care of the customers" needs while following company procedures.
• Active Listening - Ability to actively attend to, convey, and understand the comments and questions of others.
• Communication, Oral - Ability to communicate effectively with others using the spoken word.
• Communication, Written - Ability to communicate in writing clearly and concisely.
• Decision Making - Ability to make critical decisions while following company procedures.
• Interpersonal - Ability to get along well with a variety of personalities and individuals.
• Empathetic - Ability to appreciate and be sensitive to the feelings of others.
• Honesty / Integrity - Ability to be truthful and be seen as credible in the workplace.
• Responsible - Ability to be held accountable or answerable for one’s conduct.
• Organized - Possessing the trait of being organized or following a systematic method of performing a task.

Education: High School Graduate or General Education Degree (GED): Required
Bachelor's Degree (four year college or technical school) Preferred, Field of Study: health-related field and managed care experience
Valid California RN license or Licensed Clinical Social Worker (LCSW)

Minimum two years of experience in health care Ability to evaluate clinical and other health data and to communicate effectively both orally and in writing

: Required

Experience: 2 plus years of experience in health care CCM or other CM certification preferred

Care management, discharge planning, or equivalent combination of education and experience

Managed care experience in a health plan preferred Certain positions may require bilingual skills in English and Spanish

Computer Skills: Strong background and knowledge of computer systems

Certifications & Licenses:

Valid California RN license or Licensed Clinical Social Worker (LCSW) required

Other Requirements:

Ability to synthesize thoughts and plans succinctly in writing

An attitude to excel, a special empathy for working with multiple populations, an investigative personality and a willingness to mentor colleagues. A working knowledge of Medi-Cal and related policy and regulations

Ability to balance multiple tasks

Strong organizational skills Critical thinking skills Flexibility in role delineation and workload assignments Team player

N (Not Applicable) Activity is not applicable to this position.
O (Occasionally) Position requires this activity up to 33% of the time (0 - 2.5+ hrs/day)
F (Frequently) Position requires this activity from 33% - 66% of the time (2.5 - 5.5+ hrs/day)
C (Constantly) Position requires this activity more than 66% of the time (5.5+ hrs/day)

Physical Demands


10 lbs or less




11-20 lbs




21-50 lbs


Manually Manipulate


51-100 lbs


Reach Above Shoulder


Over 100 lbs




Squat or Kneel


12 lbs or less




13-25 lbs




26-40 lbs




41-100 lbs


Other Physical Requirements

• Vision

Standard Office

If you believe you would be a good fit for this fantastic opportunity, or would like to inquire about the position, please contact:
Amber Helmuth

  • Apply with Adecco

Reference number US_EN_2_108175_325831