Medical Case Manager, RN

Hourly Rate: $43.66 - $69.86/hr

Offer will be made by the client based upon experience and on their internal scale

Fully on-site

***Current, unrestricted Registered Nurse (RN) license to practice in the state of California required.***

Job Summary

One of our most presgous healthcare clients is seeking a highly motivated an experienced TEMP - Medical Case Manager (1) to join our team. Case Management is an advanced specialty collaborative practice responsible for providing ongoing case management services for members. The Medical Case Manager will facilitate communication and coordination among all participants of the health care team and members to ensure the services provided promote quality and cost-effective outcomes for all members. The incumbent will be responsible for providing intensive case management, which includes assessment, planning, implementation, coordination, monitoring and evaluation of the member’s needs.

Duties & Responsibilities:

- 85% - Care Management Assesses member needs using a standardized health needs assessment or health risk assessment. Performs comprehensive, disease specific, clinical assessments of all identified cases, which includes but is not limited to, assessment of: Member’s physical, functional, social and psychological status Member’s cultural and linguistic needs Caregiver resources and available benefits Performs post-discharge assessments to identify member’s post-hospital or post-emergency department discharge needs including but not limited to: Member’s physical, functional, social and psychological status Member’s cultural and linguistic needs Caregiver resources and available benefits Follow-up provider care and ensuring scheduled appointments Durable medical equipment and supplies Community resources Develops and implements a member’s specific care plan which includes prioritized Specific, Measurable, Achievable, Relevant, and Time-Bound (SMART) goals. Reviews, modifies and updates care plans continuously to reflect the member’s needs, at minimum, annually or upon change in condition. Schedules follow-ups to assess progress towards goals and identifies barriers to meeting goal. Provides regular outreach to assigned members along with members from a worklist and evaluates quality of service given to members according to department contact standards. Coordinates care and services with members, members’ family members/representatives and other providers, as appropriate, including community supports and Long-Term Services and Supports (LTSS). Communicates with member’s physicians, specialists, community agencies and vendors to ensure coordination of services. Facilitates referrals to behavioral health/substance use disorder services and identifies and makes referrals to LTSS department, community supports and community resources. Facilitates and participates in Interdisciplinary Team meetings as applicable. Collaborates with interdepartmental staff in case resolution as needed. Identifies cases needing supervisor, manager, director or medical director review or input, routes accordingly and closes cases according to procedures and guidelines in a timely manner. Advocates in the member’s best interest for necessary funding, treatment alternatives, timelines and coordination of care and frequent evaluations of progress and goals.
- Assesses member needs using a standardized health needs assessment or health risk assessment.
- Performs comprehensive, disease specific, clinical assessments of all identified cases, which includes but is not limited to, assessment of: Member’s physical, functional, social and psychological status Member’s cultural and linguistic needs Caregiver resources and available benefits
- Member’s physical, functional, social and psychological status
- Member’s cultural and linguistic needs
- Caregiver resources and available benefits
- Performs post-discharge assessments to identify member’s post-hospital or post-emergency department discharge needs including but not limited to: Member’s physical, functional, social and psychological status Member’s cultural and linguistic needs Caregiver resources and available benefits Follow-up provider care and ensuring scheduled appointments Durable medical equipment and supplies Community resources
- Member’s physical, functional, social and psychological status
- Member’s cultural and linguistic needs
- Caregiver resources and available benefits
- Follow-up provider care and ensuring scheduled appointments
- Durable medical equipment and supplies
- Community resources
- Develops and implements a member’s specific care plan which includes prioritized Specific, Measurable, Achievable, Relevant, and Time-Bound (SMART) goals.
- Reviews, modifies and updates care plans continuously to reflect the member’s needs, at minimum, annually or upon change in condition.
- Schedules follow-ups to assess progress towards goals and identifies barriers to meeting goal. Provides regular outreach to assigned members along with members from a worklist and evaluates quality of service given to members according to department contact standards.
- Coordinates care and services with members, members’ family members/representatives and other providers, as appropriate, including community supports and Long-Term Services and Supports (LTSS).
- Communicates with member’s physicians, specialists, community agencies and vendors to ensure coordination of services.
- Facilitates referrals to behavioral health/substance use disorder services and identifies and makes referrals to LTSS department, community supports and community resources.
- Facilitates and participates in Interdisciplinary Team meetings as applicable.
- Collaborates with interdepartmental staff in case resolution as needed.
- Identifies cases needing supervisor, manager, director or medical director review or input, routes accordingly and closes cases according to procedures and guidelines in a timely manner.
- Advocates in the member’s best interest for necessary funding, treatment alternatives, timelines and coordination of care and frequent evaluations of progress and goals.
- 10% - Administrative Support Participates in a mission driven culture of high-quality performance, with a member focus on customer service, consistency, dignity and accountability. Assists the team in carrying out department responsibilities and collaborates with others to support short- and long-term goals/priorities for the department. Follows protocol for documenting all case interventions. Prepares and maintains appropriate documentation of patient care and progress within the care plan.
- Participates in a mission driven culture of high-quality performance, with a member focus on customer service, consistency, dignity and accountability.
- Assists the team in carrying out department responsibilities and collaborates with others to support short- and long-term goals/priorities for the department.
- Follows protocol for documenting all case interventions.
- Prepares and maintains appropriate documentation of patient care and progress within the care plan.
- 5% - Completes other projects and duties as assigned.

Minimum Qualifications:
RN required PLUS 3 years of clinical experience required and/or managed care experience required; an equivalent combination of education and experience sufficient to successfully perform the essential duties of the position such as those listed above may also be qualifying.

Preferred Qualifications:

- Bachelor of Science in Nursing (BSN) degree or related field.
- Case Management Certification (CCM).
- Bilingual in English and one of the defined threshold languages (Arabic, Chinese, Farsi, Korean, Spanish, Vietnamese).

Required Licensure / Certifications:

- Current, unrestricted Registered Nurse (RN) license to practice in the state of California required.

Knowledge & Abilities:

- Develop rapport and establish and maintain effective working relationships with leadership and staff and external contacts at all levels and with diverse backgrounds.
- Work independently and exercise sound judgment.
- Communicate clearly and concisely, both orally and in writing.
- Work a flexible schedule; available to participate in evening and weekend events.
- Organize, be analytical, problem-solve and possess project management skills.
- Work in a fast-paced environment and in an efficient manner.
- Manage multiple projects and identify opportunities for internal and external collaboration.
- Motivate and lead multi-program teams and external committees/coalitions.
- Utilize computer and appropriate software (e.g., Microsoft Office: Word, Outlook, Excel, PowerPoint) and job specific applications/systems to produce correspondence, charts, spreadsheets, and/or other information applicable to the position assignment.

Physical Requirements (With or Without Accommodations):

- Ability to visually read information from computer screens, forms and other printed materials and information.
- Ability to speak (enunciate) clearly in conversation and general communication.
- Hearing ability for verbal communication/conversation/responses via telephone, telephone systems, and face-to-face interactions.
- Manual dexterity for typing, writing, standing and reaching, flexibility, body movement for bending, crouching, walking, kneeling and prolonged sitting.
- Lifting and moving objects, patients and/or equipment 10 to 25 pounds

Work Environment:

If located at the 500, 505 Building or a remote work location:

- Work is typically indoors and sedentary and is subject to schedule changes and/or variable work hours, with travel as needed.
- There are no harmful environmental conditions present for this job.
- The noise level in this work environment is usually moderate.

If located at PACE:

- Work is typically indoors in a clinical setting serving the frail and elderly.
- There may be harmful or hazardous environmental conditions present for this job.
- The noise level in this work environment is usually moderate to loud.

If located in the Community:

- Work is typically indoors and sedentary and is subject to schedule changes and/or variable work hours, with travel as needed.
- Employee will occasionally work outdoors in varied temperatures.
- There may be harmful or hazardous environmental conditions present for this job.
- The noise level in this work environment is usually moderate to loud.