Medical Case Manager

23 hours ago


Orange, California, United States talent4health Full time
Job Summary

CalOptima Health is seeking a highly motivated and experienced Medical Case Manager to join our team. As a Medical Case Manager, you will be responsible for providing ongoing case management services for our members, ensuring that they receive high-quality and cost-effective care.

Key Responsibilities
  • Assess member needs using standardized health needs assessments or health risk assessments.
  • Perform comprehensive, disease-specific clinical assessments of all identified cases.
  • Develop and implement member-specific care plans, including prioritized SMART goals.
  • Review, modify, and update care plans continuously to reflect member needs.
  • Communicate with members, physicians, specialists, community agencies, and vendors to ensure coordination of services.
  • Facilitate referrals to behavioral health/substance use disorder services and identify and make referrals to LTSS department, community supports, and community resources.
  • Participate in Interdisciplinary Team meetings as applicable.
  • Collaborate with interdepartmental staff in case resolution as needed.
Requirements
  • Current, unrestricted Registered Nurse (RN) license to practice in the state of California required.
  • Associate degree in nursing (ADN) or related field required, plus 3 years of clinical experience and/or managed care experience required.
  • Preferred qualifications include a Bachelor of Science in Nursing (BSN) degree or related field, 2 years of pediatric experience, Certified Case Manager (CCM) certificate, and bilingual in English and one of CalOptima Health's defined threshold languages.
About CalOptima Health

CalOptima Health is the single largest health plan in Orange County, serving one in four residents. Our motto — Better. Together. — is at the heart of our mission to serve members with excellence, dignity, and respect. We are a public agency made up of compassionate leaders and professionals working together to strengthen our community's health.


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