High Intensity Case Manager
2 weeks ago
Job DescriptionThe scope of the High-Risk Case Manager is to effectively manage members on an outpatient basis to ensure the appropriate level-of-care is provided for complex and chronic care needs by assessing, developing, implementing, coordinating, monitoring, and evaluating care to prevent re-admissions and ensure that the members' medical, environmental and psychosocial needs are optimize over the continuum of care.ResponsibilitiesIdentifies appropriate members for case management and conducts assessments to identify individual needs and a specific care management plan to address objectives and goals as identified during assessment.Develop Individual Care Plan (ICP) by conditions identified in health plan HRA, patient assessment, medical records authorizations/referrals, primary care physician, member, and Interdisciplinary Care Team (ICT). Setting members prioritized and self-management goals.Case Manager's ability to effectively manage a panel/caseload of high-risk members in collaboration with Nurse Practitioner, Pharmacist, PCP, SPC, health plans and other ICT members.Create cases in Essette for each case managed member with appropriate documentation including but not limited to; cognitive, functional, ADL, environmental factors, psychosocial, medical and benefits etc.Provides appropriate documentation including but not limited to; cognitive, functional, ADL, environmental factors, psychosocial, medical and benefits etc.Collaborate with member's family and physicians for seamless coordination of care and servicesCollaborate and coordinate care with Health plans, Community Based Programs (CBAS), Managed Long Term Supportive Services (MLTSS) and Behavioral Health ProvidersMonitors and evaluate effectiveness of the care management plan and modify as necessary based on members' progress, changes in condition and to minimize unnecessary utilizations, admissions, and readmissions.Interfaces with Medical Director and attends IDT as required.Conducts outbound calls to assigned high risk case managed members. Occasional, in person visit may be needed to better facilitate members' care.Collaborate with member, member's family, and physicians for seamless coordination of care and services.Collaborate and coordinate care with health plans, Community Based Programs (CBAS), Multiple Long Term Support Services (MLTSS) and Behavioral Health providers.Meet health plans and NCQA requirements in turn-around-time for assessments, care plans and IDTs.All other projects, requests and duties as assignedJob Location:Remote with Field Component as needed in Inland EmpireQualificationsMinimum Experience: At least two (2) years' experience in the medical field required. One (1) year experience in a case management role required. At least two (2) years' experience in ambulatory case management, preferably in a managed care organization, medical group, or health plan setting required. Knowledgeable in NCQA requirements preferred.Req. Certification/Licensure: RN/LVN unrestricted active license required. CCM Certification preferred.About UsWith approximately 9,000 physicians to serve our 260,000 members, Prospect Medical Systems is proud to be among the most innovative medical systems in California, Texas and Rhode Island. Our extensive care services range from primary care and specialty physician services to acute care hospital and skilled nursing facilities to behavioral health and wellness services. Each of our Independent Physician Associations (IPAs) and networks support the use of advanced diagnostic and treatment tools to provide our members with convenient access to state-of-the-art healthcare. For 25+ years, Prospect Medical has been focused on our mission of supporting independent physicians where, through risk arrangements, we work closely together with health plans, facilities and healthcare physicians for the benefit of every person who comes to us for care. We provide quality healthcare services that are designed to offer our patients highly coordinated, personalized care and that help them live healthier lives. Prospect Medical Systems manages highly successful IPAs by leveraging our best-practices, results-driven administrative services to manage patients under risk arrangements with health plans/CMS.
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High Intensity Case Manager
3 days ago
Orange, United States Alta Hospitals Full timeThe scope of the High-Risk Case Manager is to effectively manage members on an outpatient basis to ensure the appropriate level-of-care is provided for complex and chronic care needs by assessing, developing, implementing, coordinating, monitoring, and evaluating care to prevent re-admissions and ensure that the members medical, environmental and...
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High Intensity Case Manager
2 weeks ago
Orange, United States Prospect Medical Holdings Full timeThe scope of the High-Risk Case Manager is to effectively manage members on an outpatient basis to ensure the appropriate level-of-care is provided for complex and chronic care needs by assessing, developing, implementing, coordinating, monitoring, and evaluating care to prevent re-admissions and ensure that the members' medical, environmental and...
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High Intensity Case Manager
2 days ago
Orange, United States Prospect Medical Holdings Full timeThe scope of the High-Risk Case Manager is to effectively manage members on an outpatient basis to ensure the appropriate level-of-care is provided for complex and chronic care needs by assessing, developing, implementing, coordinating, monitoring, and evaluating care to prevent re-admissions and ensure that the members' medical, environmental and...
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High Intensity Case Manager
6 days ago
Orange, United States Alta Hospitals Full timeThe scope of the High-Risk Case Manager is to effectively manage members on an outpatient basis to ensure the appropriate level-of-care is provided for complex and chronic care needs by assessing, developing, implementing, coordinating, monitoring, and evaluating care to prevent re-admissions and ensure that the members’ medical, environmental and...
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Case Manager
1 month ago
Orange, United States ASTIVA HEALTH INC Full time**Job Title**: Case Manager **Target Compensation Range**: $100,000-$120,000/year, depending on level of relevant qualifications and experience. **About Us**: Astiva Health, Inc., located in Orange, CA is a premier healthcare provider specializing in Medicare and HMO services. With a focus on delivering comprehensive care tailored to the needs of our...
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Medical Case Manager
2 weeks ago
Orange, United States CalOptima Full time**Medical Case Manager (LVN) (LTSS) (Complex Discharge)** **CalOptima** **Position Information**: - Department**:Long Term Care**: - Salary Grade**:311 - $77,863 - $124,581 ($37.43 - $59.8947)**: - Work Arrangement**:Partial Telework** **This position is eligible for telework in California.*** **Duties & Responsibilities**: - 85% - Medical Review...
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Case Manager Direct Support
2 weeks ago
Orange, United States Jespy House Full timeJob Purpose Under the supervision of the Residential/Community Based Supports Supervisor, the Case Manager serves individuals with learning, developmental and behavioral health disabilities through: direct support/case management; positive direction; and, advocacy in the community on behalf of and with the client. All are accomplished in accordance with...
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Housing Case Manager
6 days ago
Orange, United States Illumination Foundation Full time"Every person deserves compassion, dignity, and the safety of a place to call home."Homelessness is the largest social and public health crisis in California. Illumination Foundation (IF) is a growing non-profit organization dedicated towards disrupting the cycle of homelessness by providing targeted, interdisciplinary services in our recuperative care...
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Case Manager
1 month ago
Orange, United States BM Healthcare Full timeWe have a contractual job as **Case Manager** for you in **Orange, CA**. If you are available in the job market. for new contract, please do let me know. **Contract Length : 13 Weeks** **Straight rate (Local) - $66hr on W2 (without stipend)** **Shift: Day 5x8-Hour (08:00 - 17:00)** **Job Type**: Contract Pay: $60.00 - $66.00 per hour Expected hours: 40...
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Housing Case Manager
5 days ago
Orange, United States Illumination Foundation Full timeJob DescriptionJob Description“Every person deserves compassion, dignity, and the safety of a place to call home.”Homelessness is the largest social and public health crisis in California. Illumination Foundation (IF) is a growing non-profit organization dedicated towards disrupting the cycle of homelessness by providing targeted, interdisciplinary...
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Case Manager Iv-orange County
4 weeks ago
Orange County, CA, United States APAIT - a division of Special Service for Groups, Inc. Full time**Summary** The Case Manager IV will be responsible for providing direct program implementation activities as an integral part of the agency’s Behavioral Health and Support Services unit under the direct supervision of the Program Manager. Responsibilities include providing Intensive Case Management Services (ICMS) for people who were are at high risk and...
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Supervisor I, Case Manager
3 weeks ago
Orange, United States HealthRIGHT 360 Full timeHealthRIGHT 360 gives hope, builds health, and changes lives for people in need by providing comprehensive, integrated, compassionate care that includes primary medical care, mental health services, and substance use disorder treatment. Benefits and perks: HR360 offers a robust benefits package, including PTO, 15 paid holidays, commuter benefits, retirement...
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Field Case Manager
6 days ago
Orange, United States Pivotal Placement Services Full timeField Case Manager (RN) This is a full-time permanent opportunity with a growing Case Management Company, which allows the nurse a lot more autonomy with their caseload with still the ability to bonus. We are looking for highly skilled, self-motivated, registered nurses (RN) who have experience with workers compensation nurse case management. Field Case...
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Transitional Flex Case Manager
6 days ago
Orange, United States Illumination Foundation Full time"Every person deserves compassion, dignity, and the safety of a place to call home."Homelessness is the largest social and public health crisis in California. Illumination Foundation (IF) is a growing non-profit organization dedicated towards disrupting the cycle of homelessness by providing targeted, interdisciplinary services in our recuperative care...
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Supervisor I, Case Manager
2 weeks ago
Orange, United States HealthRIGHT 360 Full timeHealthRIGHT 360 gives hope, builds health, and changes lives for people in need by providing comprehensive, integrated, compassionate care that includes primary medical care, mental health services, and substance use disorder treatment. Benefits and perks: HR360 offers a robust benefits package, including PTO, 15 paid holidays, commuter benefits, retirement...
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Case Manager
3 weeks ago
Orange, United States American Veterans Aid Full timeSeeking upbeat, driven individuals who are looking for a long-term position within a growing company. Our client service representatives provide valuable consultation to veterans and their families, regarding eligibility, supporting documentation, and long-term care planning. Duties & Responsibilities: Meeting and completing phone appointments with clients...
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Case Manager
2 months ago
Orange, United States AMERICAN VETERANS AID Full timeJob DescriptionJob DescriptionSeeking upbeat, driven individuals who are looking for a long-term position within a growing company.Our client service representatives provide valuable consultation to veterans and their families, regarding eligibility, supporting documentation, and long-term care planning.Duties & Responsibilities:Meeting and completing phone...
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Case Manager
5 days ago
West Orange, United States Mental Health Association Full timeJob DescriptionJob DescriptionThe mission of the Mental Health Association is to promote mental health, with the integration of physical healthcare, to improve the care and treatment of individuals with mental illness, and to remove the stigma associated with mental health disorders and addictions.MHA is seeking a full time case manager to join our...
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Inpatient Case Manager
2 weeks ago
Orange, United States Prospect Medical Full timeResponsible for coordination of daily inpatient services including assessments, treatment planning, monitoring, evaluation, documentation and discharge planning function in accordance with Prospect Medical Group policies, procedure and processes. Interacts with the Medical Directors and hospitalists on a daily basis to determine necessity of continued stay....
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Case Manager
6 days ago
Orange, United States YCS Full timeYouth Consultation Service (YCS) is a behavioral health and social services agency that has been caring for at risk children and families since 1918 in therapeutic residences, special education schools, in-home and in-community programs throughout NJ. Currently seeking a Case Manager- Duties include (but not limited to):To assist youth and their families in...
