Enhanced Case Manager

1 month ago

Ontario, United States Calibrated Healthcare Full time

Company Description

Calibrated Healthcare Network (CHN) manages over 11 million lives in over 8 states, partnering with industry leaders in managed care. Our operating model includes global workforce strategies and efficient technological solutions. CHN excels in re-engineering complex managed care business processes to provide value to partners and invests in staff, facilities, and compliance. Core services include Claims Adjudication, Utilization Management, Medical Management, and more.


Role Description

This is a full-time hybrid role for an Enhanced Case Manager - LPN at Calibrated Healthcare in Ontario, CA, with flexibility for remote work. The Enhanced Case Manager will be responsible for managing and coordinating care for patients, working collaboratively with healthcare providers, and ensuring efficient utilization of healthcare and community resources.


Position Overview:


An ECM Care Team is a multidisciplinary, integrated team comprised of four primary roles: Licensed Practical Nurse Care Manager (LPN CM), Behavioral Health Care Manager (BH CM), Care Coordinator (CC), and Community Health Worker (CHW). This job description is for the Licensed Practical Nurse Care Manager (LVN CM) position




Responsibi

li

tes:
•The LPN CM supports ECM Members with complex medical conditions or complex behavioral conditions and facilitates medication reconciliation in collaboration with RN and pharmacy as available for all ECM-enrolled

Memers;
•Responsible for primarily working with a caseload of Members with complex medical needs (primarily Tiers 1and 2 as defined in Risk Group

i

ng sction
•Engages Members and supports/encourages Member activation towards achievement of

healthgoals;
•Responsible for promoting a collaborative and effective working environment within the ECM by engaging in evidenced-based communication strategies (such as Motivational Interviewing) when discussing responsibility/sharing of tasks, effectively resolving conflicts as they arise, and collaborating on Member ca

s

e discssions;
•Tracks medical and behavioral health outcome measures in the web-based care management platform or eq

uivalentplatform
• Provides Member and family education about chronic medical and behavioral health conditions to impro

v

e healthliteracy;
•Gathers input from other ECM Care Team members to prioritize Member cases for systematic popula

tion/caselad review;
•Facilitates and ensures recommendations are communicated acros

s

the healt care team;
•Works with Members to identify health/wellness goals, and incorporates these goals into Health Action Plans/Shared Care Plan that facilitate communication amo

ng Members ad Providers;
•Champions

healthy lifetyle changes;
•Coordinates physical care management and care coordination relationships with e

xternal healthare Providers;
•Receives, identifies and follows-up t

r

eatment and meication alerts;
•Consults with the ECM Care Team members about clinical concerns or questions, and provides educational training on chronic disease states, prevention, treatment

, medications an healthy living;
•Ensures smooth transitions of care, coordination with hospitals for M1 or with IEHP transitions of care team forM2, rega

r

ding Member admision/ discharges;
•Collaborates with RN for medication reconciliati

ons with input fro the Member’s PCP;
•Tracks and assures required assessments and screenings are performed, including Comprehensive Heal

t

h Assessment and Sared Care Plan; and
•Reviews CHAs (splits role with BHCM) u

p

on completion by oter

ca

re team members

Eucational Requirement:
•Bachelor's degree in healthcare administration, public

health, nursing, socia work or

re

lated field.

Skills Experience Requirements:
•Current and unre

stricted California Licensd Practical Nurse license.
•Minimum two years direct pat

i

ent care experience in heath care or a related field.
•Minimum two years of experience in front & back office managem

ent and day to day

operation of health provideroffice.
•Driver’s license.
•Excellent communicatio

n

skills in verbal, written, ad

interpersonal communication.
Pr

o

ficient in Ec

e

  • l, Word, EMR
    •oal & Action oiLPN license a
  • nd experience in case managementStrong commun
  • ication and interpersonal skillsKnowledge of manag
  • ed care principles and practicesOrganizat
  • ional and time management skillsAbility to work ind
  • ependently and as part of a teamExperience wi
  • th healthcare technology systemsUnderstanding of h
  • ealthcare compliance regulationsDegree or extensive experience with Social

W

ork or related field is a plus. P

roficient in Excel, Word & EMR.

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