Clinical Care Manager RN Per Diem
1 day ago
Key Responsibilities:
- Evaluate and identify members' needs, developing personalized care management plans to address their requirements.
- Interface with primary care physicians, specialists, and various disciplines to develop case management plans and programs.
- Monitor and evaluate the effectiveness of care management plans, making necessary modifications to ensure optimal outcomes.
- Coordinate the interdisciplinary approach to providing continuity of care, including utilization management, transfer coordination, discharge planning, and obtaining necessary authorizations and approvals.
- Act as a clinical liaison with outside agencies, such as County CCS, non-plan facilities, and third-party administrators, to ensure seamless care coordination.
- Prepare reports, communicate program changes to staff, and develop protocols in accordance with state regulations.
- Advocate for patients, educating them on their condition and empowering them to participate in their care plan.
- Develop individualized patient education plans focused on self-management, delivering education specific to disease states.
- Facilitate patients' return to normal daily activities by teaching and making referrals for outside services and continued care.
- Consult with internal and external physicians, healthcare providers, discharge planners, and outside agencies regarding continued care, treatment, or hospitalization.
- May need to facilitate transportation and housing arrangements for patients.
- Coordinate the transmission of clinical and benefit information to patients, families, and outside agencies.
- Participate in data collection and analysis of clinical outcomes and customer satisfaction standards.
- Participate in the formulation and implementation of action strategies and outcomes of care or customer service.
- Maintain accurate records of care associated with each patient.
- Interpret regulations, health plan benefits, policies, and procedures for members, physicians, medical office staff, and contract providers and outside agencies.
- Minimum two years of clinical experience as an RN in an acute care or ambulatory care setting.
- Bachelor's degree or equivalent four years of experience required.
- Registered Nurse License (California) and Basic Life Support certification.
- Demonstrated ability to utilize and apply general and specialized principles, practices, techniques, and methods of utilization review/management, care coordination, transfer coordination, discharge planning, or case management.
- Working knowledge of regulatory requirements and accreditation standards (TJC, Medicare, Medi-Cal, etc.).
- Demonstrated ability to utilize written and verbal communication, interpersonal, critical thinking, and problem-solving skills.
- Computer literacy skills required.
- Case Management Certification or certification in the area of specialty preferred.
- Bachelor's degree in nursing or healthcare-related field preferred.
- Bilingual-Spanish speaking preferred.
- Per-diem Case Manager RN for SNP department.
- Rotating weekends.
- May float to other GPCC, TCC departments.
- May work in other AV MOBs within service areas.
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