Case Manager RN

1 week ago

Pasadena, California, United States HealthEcareers - Client Full time
Job Summary:

As a Case Manager RN with HealthEcareers - Client, you will work collaboratively with a panel of physicians to manage patients' specialized needs. Your duties will include assessing patients' needs, developing care management plans, and coordinating access to health services across multiple providers and disciplines. You will also monitor care, make determinations to arrange transportation and transfers, identify cost-effective measures, and promote self-care management.

Key Responsibilities:
  • Evaluate and identify patients' needs, and interface with primary care physicians, specialists, and various disciplines to develop case management plans.
  • Monitor and evaluate the effectiveness of case management plans and modify as necessary.
  • Coordinate the interdisciplinary approach to providing continuity of care, including utilization management, transfer coordination, discharge planning, and obtaining authorizations and approvals for outside services.
  • Act as a clinical liaison with outside agencies, such as county CCS, non-plan facilities, outside providers, employers, and third-party administrators.
  • Prepare reports, communicate program changes to staff, and develop protocols in accordance with state regulations.
  • Act as a patient advocate and educator to ensure patients have the knowledge to care for their condition and are empowered to participate in their plan of care.
  • Develop individualized patient education plans focused on self-management and deliver patient education specific to a disease state.
  • Develop and update training and educational materials and present to staff, members, and families.
  • 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 or referral to support services or placement.
  • May need to facilitate transportation and housing arrangements for patients and coordinate transmission of clinical and benefit information to patients, families, and outside agencies.
  • Participate in data collection and analysis of clinical outcomes of care and customer satisfaction standards, and participate in the formulation and implementation of action strategies and outcomes of care or customer service.
  • Ensure accurate records are maintained of the 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.
Requirements:
  • Minimum two years of clinical experience as an RN in an acute care or ambulatory care setting.
  • Experience in oncology, maternal child health, FCC, Ob/Gyn, or women's health in acute care or ambulatory care.
  • Demonstrated knowledge of maternal/fetal medicine, including high-risk pregnancies.
  • Ability to manage annual Synagis Clinic for at-risk populations.
  • Previous case management experience preferred.
  • Registered Nurse License (California).
  • Basic Life Support.
Preferred Qualifications:
  • Cancer Program: Two years of experience in ambulatory oncology.
  • Total Joint Replacement Travel Surgery Program (OC): One year of experience in total joint replacement.
  • Case Management Certification or certification in the area of specialty.

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