Case Manager II
17 hours ago
We are seeking a highly skilled Case Manager II to join our team at Community Health Group. As a key member of our healthcare team, you will be responsible for providing oversight of care coordination activities and promoting effective and appropriate utilization of services and management of members in Case Management.
Key Responsibilities- Conduct home visits for identified members to ensure timely and efficient care coordination.
- Oversight of an assigned caseload and care coordinators to ensure seamless care transitions.
- Monitor, review, and coordinate proposed inpatient, outpatient, and specialty service requests for members in Case Management, determining covered benefits based on lines of business benefit structures.
- Develop and maintain accurate documentation pertinent to member care coordination, including documentation in CHGNet Case Management application and QNXT Call Tracking system.
- Monitor inpatient and outpatient care, facilitating transition to the most appropriate levels of care, and ensuring members have access to necessary treatment plans.
- Contribute to the team effort, maintaining member confidentiality, and upholding company and product reputation.
- Conduct necessary outreach to members in Case Management for education on compliance with prescribed treatment plans.
- Assist providers and staff in identifying chronic care, case management, and disease-specific management options for identified members.
- Participate in Quality Improvement Activities (QIA) and forward quality of care concerns to the QI Department, providing case-specific follow-up for pre-determined cases.
- Research and assist in implementing processes surrounding workflow and internal guideline development to enhance member outcomes and increase customer satisfaction.
- Attend department meetings, provide feedback on existing processes, maintain patient confidentiality, and represent the department in interdepartmental and external meetings and forums as requested.
- Graduate from an accredited school of nursing or other health-related field.
- Active California RN license required or comparable credential.
- Certified Case Manager certification.
- 3 years of experience working in an acute care facility (ICU, emergency department, and/or medical/surgical unit) or outpatient healthcare setting, with 1 year of experience in a managed care environment, hospital discharge planning, or outpatient clinic.
- Bilingual preferred; English/Spanish, English/Tagalog, English/Arabic, English/Vietnamese.
- Knowledge of managed care principles preferred.
- Experience with understanding and interpreting clinical guidelines.
- Ability to communicate effectively verbally and in writing, with exceptional telephone and customer service skills, and the ability to establish effective working relationships with physicians and medical professionals.
- Will be required to conduct home and on-site visits.
- Valid driver's license, working/reliable vehicle, and automobile insurance.
- Intermittent standing, walking, bending, stooping.
- Lifting 10 lb. or less.
- Driving within San Diego County to conduct home visits required (80% field, 20% office).
- May be necessary to work and attend meetings outside of facility or normal business hours.
Community Health Group has adopted a COVID-19 vaccination policy to safeguard the health and well-being of our employees. As a condition of employment, our employees are required to be fully vaccinated for COVID-19, unless a reasonable accommodation is approved or as otherwise required by law.
Community Health Group is an equal opportunity employer that is committed to diversity and inclusion in the workplace. We prohibit discrimination and harassment based on any protected characteristic as outlined by federal, state, or local laws. This policy applies to all employment practices within our organization, including hiring, recruiting, promotion, termination, layoff, recall, leave of absence, compensation, benefits, and trainings. Community Health Group makes hiring decisions based solely on qualifications, merit, and business needs at the time.
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