Senior Case Manager

New

A Senior Case Manager position is available through Adecco Medical and Science with one of the leading health plan providers in Rancho Cordova, CA. You will be responsible for collaborating with other members of the health care team in to determine and develop individualized care plans for patients. You must have an active CA State RN License and experience in an acute care setting.

Senior Case Manager Job Responsibilities include:

Determines, develops and implements the plan of care based on accurate assessment of the member and current or proposed treatment plan in cases of: member inquiry, triage hub, chronic conditions, poly-pharmacy, pre-natal care, and voluntary member health assessment, in addition to indication of multiple monthly ER visits.
Apply detailed knowledge of medical/departmental policies, clinical practice guidelines, community resources, contracting and community care standards to each case.
Researches and designs treatment /care plans to promote quality of care, cost effective health care services based on medical necessity complying with contract for each appropriate plan type. Implements discharge (DC) planning activities for medically complex cases.
Determines appropriateness of referral for CM services.
Provides Referrals to Quality Management (QM), Disease Management (DM) and Appeals and Grievance department (AGD).
Conducts member care review with medical groups or individual providers for continuity of care, out of area/out of network and investigational/experimental cases.
Manages member treatment in order to meet recommended length of stay. Ensures DC planning at levels of care appropriate for the members needs and acuity.
Assesses members health behaviors, cultural influences and clients belief/value system. Evaluates all information related to current/proposed treatment plan and in accordance with clinical practice guidelines to identify potential barriers.
Designs appropriate and fiscally responsible plan of care with targeted interventions that enhance quality, access and cost-effective outcomes.
Advocates understanding and respect for the beliefs, value system, and decisions of the client.



Qualifications:

California RN license
Bachelors of Science in Nursing or advanced degree preferred.
Certified Case Manager (CCM) or within one year of hire.
Extensive acute care experience


If you are interested in this Senior Case Manager position in Rancho Cordova, CA then please click APPLY NOW. For other opportunities available at Adecco Medical and Science go to www.adeccousa.com. If you have questions about the position or would like more information, please contact Kayla Hanscom at 650-745-3112 or by email at Kayla.Hanscom@adeccona.com.


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Reference number US_EN_2_108218_332590