Specialty Registered Nurse Case Manager

1 week ago

Alhambra, California, United States HealthEcareers - Client Full time
Position Overview:

The Specialty Registered Nurse Case Manager plays a crucial role in collaborating with a designated group of healthcare providers to address the unique needs of patients with chronic conditions. The role involves a comprehensive assessment to determine patient requirements and the formulation of tailored care management strategies. In partnership with physicians, the Case Manager facilitates access to necessary health services across various providers and disciplines, oversees patient care, coordinates transportation when necessary, identifies cost-effective solutions, and recommends alternative care options. This position emphasizes patient self-management and ensures all necessary documentation is completed. The Case Manager operates as an indirect caregiver and is expected to work effectively within a multidisciplinary team.

Key Responsibilities:
  • Assess and identify patient needs, collaborating with Primary Care Physicians, Specialists, and other healthcare professionals to develop effective case management plans.
  • Continuously monitor and evaluate the success of case management strategies, making adjustments as needed.
  • Facilitate a coordinated approach to ensure seamless continuity of care, including managing utilization, transfer coordination, discharge planning, and securing necessary authorizations for external services.
  • Serve as a clinical liaison with external agencies, including County CCS, non-plan facilities, and third-party administrators.
  • Prepare and present reports, communicate changes in programs to relevant staff, and develop protocols in line with state regulations.
  • Act as an advocate and educator for patients, ensuring they understand their conditions and are empowered to engage in their care plans.
  • Create personalized education plans for patients and families, focusing on self-management and specific disease states.
  • Develop and update training materials, delivering educational sessions to staff, members, and families. Assist patients in resuming daily activities by providing referrals for ongoing care.
  • Consult with healthcare providers and agencies regarding ongoing treatment, hospitalization, or referrals to support services.
  • Coordinate transportation and housing arrangements for patients as necessary, ensuring effective communication of clinical and benefit information.
  • Participate in data collection and analysis related to clinical outcomes and patient satisfaction, contributing to the development and monitoring of care strategies.
  • Interpret regulations, health plan benefits, and policies for members, physicians, and external agencies.
Qualifications:
Experience
  • At least two (2) years of clinical experience as a Registered Nurse in an acute or outpatient care environment is required.
Education
  • Bachelor's degree or equivalent experience (four years) is required.
License, Certification, Registration
  • Current Registered Nurse License (California)
  • Basic Life Support certification
Additional Qualifications:
  • Proven ability to apply principles and techniques of utilization review, care coordination, and case management.
  • Familiarity with regulatory standards and accreditation requirements (TJC, Medicare, Medi-Cal, etc.).
  • Strong communication, interpersonal, critical thinking, and problem-solving skills are essential.
  • Proficiency in computer skills is required.
  • Bilingual (English/Spanish) Level II is required.
Preferred Qualifications:
  • Certification in Case Management or a relevant specialty is preferred.
  • Bachelor's degree in nursing or a related healthcare field is preferred.
  • Experience in complex case management, Medicare, and Medi-Cal is advantageous.
Notes:
  • Must have successfully completed or passed the bilingual test within the last year or be active in the QBS program.
  • This role will support the Special Needs Program and may also assist with Geriatrics and Palliative Care as needed.
  • Availability to work on Saturdays is required.

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