RN case manager La Palma

Pay Rate:34/hr

The SNP / CMC Care Manager is responsible for managing low and moderate risk Special Needs Population (SNP) and Dual Eligible (DE) members. SNP / CMC Care Manager will ensure that the SNP and DE receive an assessment. Ensures the individualized care plan is developed and presented timely to the IDCT.
RESPONSIBILITIES AND FUNCTIONS
§ Managers a case load of 400-600 low to moderate risk SNP and or CMC members.

§ Coordinates and schedules all IDCT meetings

§ Ensures all SNP and DE members are presented at IDCT at least annually

§ .Facilitates Primary Care Provider attendance

§ Ensures SNP and DE member and or caregiver participation

§ Obtains the health plan HRA from various websites

§ Oversees the low risk SNP and DE population and ensures the annual review of the care plan is completed for those members who did not have a change in health status.

§ Manages all communication and information flow

§ Completes the model of care training annually

§ Works collaboratively with the patient, physician, family/significant other and providers of healthcare to implement plan of care to meet the individual needs.

§ Works collaboratively with discharge planners at the affiliated hospitals and case management staff to identify changes in health status.

§ Coordinates referrals to LTSS as indicated.

§ Provides patients with education and training regarding specific health care needs.

§ Monitors care, which is easily accessible with no access barriers as related to the patient’s available benefits.

§ Facilitates early and intensive treatment intervention in the least restrictive setting.

§ Facilitates the scheduling of follow up services as appropriate.

§ Provides accurate and up-to-date information to practitioners regarding clinical practice guideline criteria and patient information.

§ Creates individualized treatment plans that incorporate the HRA, community LTSS services

§ Utilizes multidisciplinary clinical, rehabilitative and support services.

§ Grants adequate attention to patient satisfaction through the evaluation and improvement of the care coordination process.

§ Upholds strict rules of confidentiality.

§ Provides ongoing Care coordination program analysis and development.

§ Encourages collaborative collegial approaches to the Case Management process.

§ Promote the Care coordination Program’s viability and accountability.

§ Other duties as assigned

Level of Education : Associates degree in Nursing or BSN preferred

Professional Certification or License
• Active RN or LVN license in the State of California
• Valid California Driver’s license and insurance
Level of Experience
• A minimum of 2 years experience in managed care environment, preferably in an IPA or MSO. Other case management experience will be considered.

Specific Knowledge, Skills, and Abilities
• Knowledge of HMO UM and QM Processes.
• Knowledge of and experience with the utilization of UM criteria such as Milliman & Robertson, Medicare and Medicaid guidelines, health plan criteria, etc.
• General knowledge of IPA Operations
• Familiar with various financial risk arrangements
• Computer literate in Microsoft Word and Excel.
• Strong verbal and written communication skills.
• Knowledge of and experience with medical coding.
• Strong ability to work effectively with physicians and other clinical and operational staff, both written and verbally.
• Self motivated with strong organizational skills.
• Ability to look at challenges as opportunities.
• Flexible and adaptable of schedule to attend various meetings and/or promotional events.
• Ability to read quickly with excellent comprehension and retention.

What software skills are needed? They need to know Outlook, MS Office
What are the hours? ( Training hours?) Hours are 8-5 with a 1 hour lunch or 8:30 – 5 with ½ hour lunch. Training hours about 1 week
Will you be interviewing (face to face or phone) Need face to face interview
Please confirm the worksite location – location is 18 Centerpointe Drive, La Palma, CA 90623

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Reference number US_EN_2_108175_331773