Advanced Case Management Nurse

2 weeks ago

Alameda, California, United States Alameda Alliance Full time

KEY RESPONSIBILITIES:

This role operates under the direct oversight of the Case Management Supervisor and is accountable for the effective execution of the organization's case management and care coordination initiatives.

The Advanced Case Management Nurse will deliver case management services to health plan members facing intricate medical and psychiatric challenges, necessitating advocacy and coordination to assist members in achieving optimal functional independence and autonomy. This position involves close collaboration with a multidisciplinary team, including a Medical Social Worker and a Health Navigator. This cooperative approach to case management will engage key departments within the health plan, such as Utilization Management and Pharmacy, which may offer clinical insights and real-time data on patient utilization trends. Externally, the team will liaise with community partners to facilitate referrals for care and resources, ensuring comprehensive management of members across various healthcare systems. The primary objective of the Advanced Case Management program is to enhance members' quality of life while ensuring cost-effective outcomes through the utilization of all available and suitable resources.

Core Duties Include:

  • Conducting assessments, planning, facilitating, and advocating for members in collaboration with healthcare resources involved in their care.
  • Working in tandem with both licensed and unlicensed personnel to co-manage complex cases through regular communication with members, caregivers, and healthcare professionals.
  • Managing a caseload of members, both individually and collaboratively as part of a team.
  • Serving as a subject matter expert on nursing processes and perspectives for the team.
  • Overseeing triage and all aspects of the nursing process, including assessment, diagnosis, planning, implementation, and evaluation of care.
  • Creating multidisciplinary care plans with input from members and primary care providers to address identified health issues using evidence-based goals and interventions.
  • Participating in the ongoing identification of health plan members at high risk for adverse health outcomes who require care management services.
  • Engaging in weekly Multidisciplinary Care Team Meetings and presenting complex medical cases to the broader department team.
  • Collaborating with Health Homes members enrolled in internal Community-Based Care Management Entities in accordance with regulatory guidelines.
  • Coordinating closely with the health plan's providers, particularly the members' primary care and specialty providers, to deliver highly coordinated and specialized care.
  • Assessing both medical and social determinants of health for members.
  • Communicating with providers, members, and community resources as needed to support the planning, implementation, and evaluation of care management programs.
  • Employing a patient advocacy approach to ensure seamless integration of services within the member's benefit structure.
  • Completing additional duties and special projects as assigned.

ESSENTIAL FUNCTIONS:

  • Facilitating communication and coordination of necessary services for members with primary care providers and specialists.
  • Documenting and managing casework in compliance with accreditation standards and regulatory requirements.
  • Building and maintaining effective relationships with designated members and their families or caregivers.
  • Maintaining accurate case management records.
  • Developing appropriate care plans and assessments for members.
  • Serving as a clinical resource for staff as needed.
  • Conducting writing, administration, analysis, and report preparation.
  • Researching and establishing working relationships with relevant community resources to support members.
  • Providing guidance to ancillary team members who assist with additional coordination activities for managed health plan members.
  • Adhering to the organization's Code of Conduct, regulatory requirements, and internal policies.

PHYSICAL DEMANDS:

  • Consistent and close visual work at a desk or computer.
  • Frequent sitting and desk work.
  • Regular data entry using a keyboard and/or mouse.
  • Frequent use of a telephone headset.
  • Regular verbal and written communication with staff and business associates.
  • Occasional lifting of objects weighing between 0 and 30 lbs.
  • Frequent walking and standing.

SUPERVISORY RESPONSIBILITIES: None

MINIMUM QUALIFICATIONS:

  • Bachelor's or Master's degree in Nursing required.
  • Active and unrestricted Registered Nurse license in the State of California prior to employment.
  • Certification in case management preferred or willingness to obtain certification within a specified timeframe.

EXPERIENCE:

  • A minimum of three years of experience in clinical case management is required.
  • Three years of clinical experience in an acute care setting is preferred.
  • A Master's degree in Case Management may substitute for the required clinical experience.

SKILLS AND ABILITIES:

  • Exceptional verbal and written communication skills.
  • Familiarity with Medi-Cal and Medicare regulations is advantageous.
  • Ability to motivate and engage members effectively.
  • Knowledge of community resources is beneficial.
  • Strong organizational skills to prioritize caseload effectively.
  • Proficiency in Microsoft Office Suite and familiarity with Care Management Software applications is a plus.

All employees interacting with the public may be required to undergo testing for Tuberculosis and be fully vaccinated against COVID-19 and influenza. Successful candidates may need to provide proof of vaccination or request an exemption for qualifying medical or religious reasons during the onboarding process.

SALARY RANGE: $105,853.04 - $158,779.55 Annually

Alameda Alliance is an equal opportunity employer, making employment decisions based on qualifications and merit. We are committed to having the most qualified individuals in every position. Our policy prohibits discrimination based on race, color, creed, gender, religion, veteran status, marital status, registered domestic partner status, age, national origin, physical or mental disability, medical condition, genetic characteristic, sexual orientation, gender identity or expression, or any other unlawful consideration.

  • Travel Physical Therapist

    2 days ago

    Alameda, California, United States Wellspring Nurse Source Full time

    Wellspring Nurse Source is seeking a skilled Physical Therapist to fill a travel job opportunity in a dynamic healthcare setting.Job Details:Specialty: Physical TherapistDiscipline: TherapyEmployment Type: TravelShift: 8 hours, daysHours per Week: 40About the Job:As a travel Physical Therapist with Wellspring Nurse Source, you will have the opportunity to...

  • Medical Social Services Manager

    3 days ago

    Alameda, California, United States Kaiser Full time

    Job Summary:Kaiser Permanente seeks a highly skilled Medical Social Services Manager to lead our social services programs. As a key member of our team, you will be responsible for developing and monitoring social services programs, establishing and maintaining standards, quality levels, cost-effective services, and customer-focused services. You will also...

  • Advanced Regulatory Affairs Expert

    2 weeks ago

    Alameda, California, United States Abbott Laboratories company Full time

    About Abbott LaboratoriesAbbott Laboratories is a leading global healthcare organization dedicated to enhancing the quality of life for individuals at every stage of their journey. Our extensive range of innovative technologies encompasses diagnostics, medical devices, nutritional products, and branded generic medications. With a workforce of 114,000...

  • Registered Nurse

    3 days ago

    Alameda, California, United States CenterWell Home Health Full time

    About the RoleCenterWell Home Health is seeking a skilled and compassionate Registered Nurse to join our team as a Home Health Care Specialist. As a key member of our care team, you will play a vital role in delivering high-quality, patient-centered care to individuals in the comfort of their own homes.Key ResponsibilitiesProvide comprehensive nursing care...

  • Compassionate Caregiver

    2 weeks ago

    Alameda, California, United States ModernHR Full time

    ModernHR is dedicated to providing exceptional skilled care and support to individuals in need. Our commitment to creating a nurturing environment ensures that our residents experience the comfort and security essential for their well-being. We adopt a holistic approach to patient care, focusing on the individual needs of each resident. Our emphasis on...

  • Retail Store Manager

    3 days ago

    Alameda, California, United States Savers Value Village Full time

    Job DescriptionJob Title: Retail Store ManagerJob Summary:Savers, a leading international thrift retailer, is seeking a highly skilled Retail Store Manager to join our team. As a Retail Store Manager, you will be responsible for overseeing the daily operations of our store, ensuring excellent customer service, and driving sales growth.Key...

  • Lead Technical Program Manager

    2 weeks ago

    Alameda, California, United States ZipRecruiter Full time

    The CompanyZipRecruiter's mission is to connect job seekers with opportunities that enhance their lives. As a leading online employment marketplace, ZipRecruiter leverages advanced technology to streamline the hiring process, making it easier for employers to find the right candidates.Since its inception, ZipRecruiter has transformed the way businesses...

  • Assistant Store Manager

    2 weeks ago

    Alameda, California, United States O'Reilly Auto Parts Full time

    Compensation Pay Range:$24.50This position involves assisting in the management of store operations and supporting the team in delivering exceptional customer service.O'Reilly Auto Parts is recognized for its consistent growth and reliability. We pride ourselves on a robust internal promotion strategy, empowering you to advance your career alongside our...

  • Care Coordination Specialist

    2 weeks ago

    Alameda, California, United States Alameda Alliance for Health Full time

    KEY RESPONSIBILITIES: Under the guidance of the Non-Clinical Supervisor in Case Management, the Health Navigator will assist members in navigating case management and disease management initiatives. The Health Navigator will oversee a continuous caseload with assistance from clinical personnel as required. This position emphasizes care coordination, offering...

  • Manager of Financial Analysis

    5 days ago

    Alameda, California, United States Abbott Laboratories Full time

    About Abbott LaboratoriesAbbott Laboratories is a global healthcare leader that helps people live more fully at all stages of life. Our portfolio of life-changing technologies spans the spectrum of healthcare, with leading businesses and products in diagnostics, medical devices, nutritionals and branded generic medicines. Our 114,000 colleagues serve people...

  • Senior Product Marketing Manager

    2 weeks ago

    Alameda, California, United States Abbott Laboratories Full time

    About AbbottAbbott stands as a leader in global healthcare, pioneering innovative science to enhance health outcomes. We consistently look ahead, anticipating advancements in medical science and technology.Working at AbbottAt Abbott, you will engage in meaningful work, experience personal growth, and enjoy a fulfilling life. Our offerings include:Career...

  • Senior Speech Language Pathologist

    2 weeks ago

    Alameda, California, United States John George Psychiatric Pavilion Full time

    SUMMARY: The Senior Speech Language Pathologist (SLP) plays a pivotal role in managing the operations of the Speech Therapy Department under the direction of the Rehabilitation Manager. This position involves supervising SLPs, formulating treatment plans, and providing care for both inpatient and outpatient Speech Therapy clients. Additional responsibilities...

  • Quality Engineering Manager

    1 week ago

    Alameda, California, United States Abbott Full time

    Company OverviewAbbott is a leading global healthcare organization dedicated to enhancing the quality of life for individuals at every stage of their health journey. Our extensive portfolio includes innovative technologies across diagnostics, medical devices, nutrition, and branded generic medicines. With a workforce of 114,000 professionals, we are...

  • Strategic Sourcing Manager

    2 weeks ago

    Alameda, California, United States Abbott Full time

    About AbbottAbbott is a prominent global healthcare organization dedicated to enhancing the quality of life for individuals at every stage of their health journey. Our extensive range of innovative technologies encompasses diagnostics, medical devices, nutritionals, and branded generic medicines, with a workforce of 114,000 professionals serving clients in...

  • Senior Product Marketing Manager

    2 weeks ago

    Alameda, California, United States Abbott Laboratories Full time

    About AbbottAbbott stands as a premier global leader in healthcare, dedicated to pioneering scientific advancements that enhance health outcomes. Our vision is always forward-thinking, anticipating the evolving landscape of medical science and technology.Why Work at Abbott?At Abbott, you have the opportunity to engage in meaningful work, pursue personal...

  • Critical Care Nurse Specialist

    1 hour ago

    Alameda, California, United States United States Air Force Full time

    Job Summary:The United States Air Force is seeking highly skilled Critical Care Nurses to join our team. As a Critical Care Nurse, you will be responsible for providing comprehensive care to patients with severe medical conditions or injuries.Key Responsibilities:Execute complex, intensive nursing care to patients with severe medical conditions or...

  • Senior Product Marketing Manager

    1 week ago

    Alameda, California, United States Abbott Laboratories Full time

    About AbbottAbbott stands as a prominent entity in the global healthcare sector, pioneering innovative scientific solutions aimed at enhancing health outcomes. Our focus is on anticipating advancements in medical science and technology to better serve our community.Life at AbbottAt Abbott, we empower you to engage in meaningful work, pursue personal growth,...

  • Senior Product Marketing Manager

    1 week ago

    Alameda, California, United States Abbott Laboratories Full time

    About AbbottAbbott stands as a prominent leader in the global healthcare sector, dedicated to pioneering scientific advancements that enhance health outcomes. Our focus is on anticipating the evolving landscape of medical science and technology.Working at AbbottAt Abbott, you will engage in meaningful work, experience personal and professional growth, and...

  • Quality Engineering Manager

    2 weeks ago

    Alameda, California, United States Abbott Full time

    Company OverviewAbbott is a leading global healthcare organization dedicated to enhancing the quality of life for individuals at every stage of their health journey. Our diverse portfolio includes innovative technologies across diagnostics, medical devices, nutritionals, and branded generic medicines, supported by a workforce of 114,000 professionals in over...

  • Senior Product Marketing Manager

    2 weeks ago

    Alameda, California, United States Abbott Laboratories Full time

    About AbbottAbbott stands as a prominent leader in the global healthcare sector, dedicated to pioneering scientific advancements that enhance health outcomes. Our vision is always forward-thinking, as we anticipate shifts in medical science and technology.Life at AbbottAt Abbott, you will engage in meaningful work, fostering personal and professional growth...