Basic Case Management Nurse I

Organizational Description

The Community Health Center Network (CHCN), sister organization to the Alameda Health Consortium, is made up of the eight federally qualified community health centers in Alameda County. CHCN functions as the managed care MSO for our health centers, contracting with the Alameda Alliance for Health. In order to help our health centers meet their missions of providing the best possible care to their communities, we also provide a broad range of training, technical assistance, quality improvement, information technology, and data analytic services.

Position Title: BCM Nurse I

Department: Utilization Management (UM)

Reports To: BCM Supervisor

Classification: Non-Exempt

Status: Full-Time (Temporary), Remote/Hybrid

POSITION SUMMARY

The Basic Case Management (BCM) Nurse I will proactively coordinate and assist with the Care Coordination needs of CHCN members and assist with outpatient UM. BCM Nurses work collaboratively with CHCN members, physicians, nurses, and multidisciplinary teams within the PCP clinic setting, managed Medi-Cal Health plans, Outpatient Case Managers, CCS Case Managers and specialty providers. BCM Nurses activities include member outreach, identification of resource needs, Care Coordination, multiple member cases and proactive follow-up with assigned caseloads. Additionally, the BCM Nurse supports the BCM team with collaboration of Case Management (CM) duties to include delegation of administrative work to BCM Coordinators. The BCM Nurse works as a fully, functioning team player with the entire UM Department, in succession with outside entities.

ESSENTIAL POSITION RESULTS

The essential functions listed are typical examples of work performed by positions in this job classification. They are not designed to contain and/or be interpreted as a comprehensive inventory of all duties, tasks and responsibilities. Employees may perform other duties as assigned.

• Ability and desire to advocate for managed Medi-Cal patients and help them achieve their best health. Proactively and collaboratively, interface with clinics, HMOs, physicians, internal staff, members and their families to assist in proper Care Coordination duties.

• Refer members to various other departments (Health Plan Complex Case Management/Case and Disease Management) for follow-up as appropriate with medically complex members.
• Refer members to Behavioral Health, QI and Care Neighborhood programs inside and outside the organization.
• Build and maintain appropriate relationships on behalf of CHCN.
• Support a positive work environment and foster teamwork.
• Effectively manage a multitude of various functions while focusing on member case outreach and Care Coordination needs.
• Effectively multi-task and willingness to learn new computer programs and systems within the organization.
• Ability to identify patient insurance coverage and understand the coverage benefits of Medi-Cal, Medicare and Group Care.
• Ability to assess new patients, evaluate and determine of patient’s needs.
• Able to provide available services and resources to patients.
• Educate patients and families about health care plans and options.
• Document accurately in medical records.
• Provide emotional support to patients and families.
• Demonstrate understanding of medical knowledge, such as diagnostic procedures, medication, symptoms, medical treatments and therapies.
• Able to work in a stressful and/or busy environment.
• Act as a patient advocate.
• Make sure the patient is getting medically necessary care, quality care, and the care is being efficiently and economically as possible.

SUPERVISORY RESPONSIBILITIES

None

MINIMUM QUALIFICATIONS:

Competencies:

• Effective leadership and administrative skills.
• Good communication and customer relations’ skills; ability to work well with a team and independently.
• Utilization Management and Case Management experience, understanding and knowledge of healthcare benefits associated with various business lines (Medi-Cal, Medicare, and Commercial).
• Ability to work independently in most instances, requiring limited supervision.
• Proficiency in computer operations, navigational skills and comfortable with Internet-based applications.
• Sound decision-making skills including problem solving, critical thinking, and good clinical judgment for clinical and non-clinical issues.
• Professional demeanor.

Essential Requirements

• Active, unrestricted, California Registered Nursing License.
• Minimum one to two years of CM or UM experience in an outpatient or insurance payor setting, preferred.
• Ability to learn new roles/tasks and workflows within the organization.
• Excellent communication, organizational and time management skills with the ability to meet turn-around times.
• Ability to work effectively and collaboratively with a variety of individuals, inclusive of PCP office, personnel/office staff, health plans, members and physicians.

• Strong understanding of the Managed Care environment and the MSO partnership.
• Ability to meet member’s challenging needs with extensive collaboration with the Health Plan partners.
• Maintain a reasonable and compliant caseload of BCM referrals that include TN (Transition into Network), COC (Continuity of Care), CC (Care Coordination), and CCS/TN (California Children’s Services Transition into Network)
• Conduct member outreach and case management assessments and escalate cases to higher level BCM Nurse and/or to the BCM Supervisor as needed.

General CHCN roles

• Fosters an environment that promotes trust and cooperation among clients, clinical care team, and CHCN staff.
• Enforces policies and procedures, including maintenance of client confidentiality, to ensure that the principles of CHCN are implemented.
• Accountable for participating in decision-making processes and understanding the outcome(s).
• Understands the values and principles of CHCN and applies them in work responsibilities.
• Participates in Case Management meetings as well as outreach activities, agency advocacy, and serves on ad hoc committees, as requested.

LICENSE REQUIREMENTS:

Unrestricted California RN license.

PHYSICAL DEMANDS

The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

While performing the duties of this Job, the employee is regularly required to sit and use hands to finger, handle, or feel. The employee is frequently required to talk or hear. The employee is frequently required to stand; walk; reach with hands and arms and stoop, kneel, crouch, or crawl. The employee must occasionally lift and/or move up to 15 pounds. Specific vision abilities required by this job include close vision and ability to adjust focus.

WORKING CONDITIONS AND ENVIRONMENT

The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

While performing the duties of this job, the employee is regularly exposed to an inside environment.

The Community Health Center Network is an Equal Opportunity Employer.