Care Manager
4 weeks ago
**Care Manager (Transitional Care Services Maternal Health)**
**CalOptima**
**CalOptima Health** is seeking a highly motivated an experienced **Care Manager (Transitional Care Services Maternal Health)** to join our team. Case Management is an advanced specialty collaborative practice, responsible for providing ongoing case management services for CalOptima Health's members. The Care Manager for Transitional Care Services (TCS) Maternal Health will facilitate communication and coordination among all participants of the health care team and the member to ensure the services provided promote quality and cost-effective outcomes for all members along with focus on pregnant or 12-month postpartum members who have recently discharged from the hospital or emergency department (ED). The incumbent will be responsible for providing intensive case management, which includes assessment, planning, implementation, coordination, monitoring and evaluation of the member's needs
**Position Information**:
- Department**:Case Management**:
- Salary Grade**:310 - $72,096 - $115,353 ($34.66 - $55.4582)**:
- Work Arrangement**:Full Telework**
**This position is eligible for telework in California.***
**Duties & Responsibilities**:
- 85% - Care Management
- Assesses member needs using a standardized health needs assessment or health risk assessment with member or member's representative.
- Performs post-discharge assessment to identify member's post-hospital or post-ED 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.
- Collaboration with the member's Medical Therapy Program and Regional Center Service Coordinator if appropriate.
- Develops and implements a member's specific care plan which includes prioritized SMART goals.
- Care plan will be continuously reviewed, modified and updated to reflect the member's needs.
- Schedules weekly follow-ups with member or member's representative to assess progress towards goals and identifies barriers to meeting goals.
- Provides regular outreach to assigned members along with assigned 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 LTSS.
- Conducts face-to-face meetings at settings outside of CalOptima Health's locations such as in hospitals, skilled nursing facilities, long-term acute care hospitals, recuperative care and in member's home settings with members, members' family members/representatives and other providers, as appropriate.
- 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 Long-Term Support Services (LTSS) department, Community Supports and community resources.
- Facilitates and participates in Interdisciplinary Care Team meetings as applicable.
- Collaborates with interdepartmental staff in case resolution as needed.
- Identifies cases needing manager, director or medical director review or input, routes accordingly and closes cases according to procedures and guidelines in a timely manner.
- Prepares and maintains appropriate documentation of patient care and progress within the documentation platform or care plan as appropriate. 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 CalOptima Health's protocol for documenting all case interventions. Ensures reporting of productivity metrics to supervisor.- 5% - Completes other projects and duties as assigned.
**Minimum Qualifications**:
- Bachelor's degree in social work, psychology, gerontology, public health or related field required.
- 5 years of clinical experience 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 is also qualifying.
- Valid driver's license and vehicle or other approved means of transportation, an acceptable driving record and current auto insurance will be required for work away from the primary office 20% of t
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