RN Case Manager

3 weeks ago

Santa Barbara, United States Impresiv Health Full time
Title: Health Plan Nurse Coordinator

Duration: Temporary until 7/31/24

Compensation: $47/hour

Description: Our client is looking for a Health Plan Nurse Coordinator (RN) to support their case management team.

What You Will Do:
  • Comply with HIPAA, Privacy, and Confidentiality laws and regulations.
  • Adhere to Health Plan, Medical Management, and Health Services policies and procedures.
  • Effectively communicate, verbally and in writing, with providers, members, vendors, and other healthcare providers in a timely, respectful, and professional manner.
  • Function as a collaborative member of Medical Management/Health Services' multidisciplinary medical management team
  • Identify and report quality of care concerns to management and, as directed, to the appropriate department for follow-up.
  • Support and collaborate with management, medical management, and health services team members in implementing and managing Utilization Management, Case Management, Disease Management, Population Health, Care Coordination, and Care Transition activities in Transition Care Services.
  • Adhere to mandated reporting requirements appropriate to professional licensing requirements.
  • Attend and actively participate in department meetings.
  • Actively participate in developing, implementing, and evaluating department initiatives to assess any measurable improvements to member's quality of care.
  • Keep abreast of health care benefits and limitations, regulatory requirements, disease processes and treatment modalities, community standards of patient care, and professional nursing standards of practice.
  • Embrace innovative care strategies that build value-based programs.
  • Act as a liaison primarily to providers and employees regarding UM processes and operational standards.
  • Timely review of requests for referrals and services
  • Application and interpretation of established clinical guidelines and benefits limitations.
  • Accurate decision-making skills to support the appropriateness and medical necessity of requested services.
  • Document clear and concise case review summaries.
  • Perform selective claims review.
  • As assigned, perform on-site reviews of members in the acute hospital, skilled nursing facility, and other inpatient settings.
  • As assigned, conduct a face-to-face assessment of the member with their authorized representative, family, caregiver, etc., to complete necessary assessments, such as the Community-Based Adult Services (CBAS) assessment tool.
  • Coordinate quality and cost-effective medically necessary health care services for members receiving CM services.
  • Facilitate and assist members with accessing care.
  • Effectively and efficiently implement and complete the case management process. This process involves health screening, assessment, and planning.
  • Facilitating, coordinating, monitoring, and measuring the member's care, progress, and compliance
  • Develop, update, and monitor member-centered, individualized care plans developed with the member's input and meet regulatory requirements.
  • Conduct timely telephonic assessments, surveys, and questionnaires that meet policies and regulatory standards.
  • Accurate and timely determination of member risk levels based on assessment, survey, or questionnaire findings and results.
  • Accurate classification, e.g., program type, acuity, intensity, and service level of assigned cases.
  • Document clear and concise case contact summaries and care plan reviews.
  • Adhere to governing regulatory agencies' timeline standards for risk assessments/surveys/questionnaires, care plan development, and processes.
  • Collaborate with contracted agencies and community-based organizations to provide supportive services when needed (Home Health agencies, Outpatient Therapy Units, Meals on Wheels, Recuperative Care, Shelters, Transportation, Adult Day, etc.)
  • Coordinate timely care transition from one level of care to another, such as acute care to SNF or SNF to home or other living arrangements, as the member's care needs change.
  • Effectively communicate and educate members about the health care delivery system and health plan benefits and limitations.
  • Assist members in navigating the healthcare delivery system.
  • Empower members by providing community resources, educational materials, and self-managing tools.
  • Promote wellness and healthy living lifestyles to enhance or maintain physical and mental functional capabilities.
  • Assess the member's care needs, identify interventions, develop care plans, implement and facilitate necessary services, and establish timelines for case management services.
  • As appropriate, address aging-out and transitional requirements into adulthood in care coordination and care planning activities.
  • Other duties as assigned
You Will Be Successful If:
  • You understand "whole person" "person centered" case management
  • You possess knowledge of community-based resources such as transportation, food banks, mental health, resource centers, etc.
  • You have a thorough understanding of Utilization Management processes and turnaround times
  • You have a customer service mindset, with great phone etiquette
  • You have a professional demeanor and can work effectively and collaboratively with cross-functional teams
  • You demonstrate clinical knowledge of health conditions and disease processes
  • You are an excellent communicator in writing, in person, and over the phone with members and their families, physicians, and other healthcare providers
  • You have a thorough understanding of basic utilization review principles, primary case and disease management, quality improvement, and population health
  • You are a strong multitasker with a high degree of organizational and time managements skills and can demonstrate proficiency in organizing and managing work assignments.
  • Demonstrate proficiency in CM database software
  • Demonstrate proficiency in the development, implementation, and outcome measurements of Individualized Care Plans (ICP)
  • Proficient in Medi-Cal coverage and limitations
What You Will Bring:
  • Current and unrestricted California RN License
  • 2+ years of experience in Case Management
  • Previous experience working in managed care or with an MCO
  • Proficiency in eligibility and clinical guidelines
  • Previous experience completing Assessments and building Individual Care Plans
  • Knowledge of Medi-Cal and Medicare health benefits, managed care regulations, benefits, contract limitations, deliver and reimbursement systems, and medical management activities
  • Certifications in case management, utilization, quality preferred (CCM, CMCN, CPHQ, HCQM, CPUM, CPUR, etc.)
  • Bilingual in Spanish required.


About Impresiv Health:

Impresiv Health is a healthcare consulting partner specializing in clinical & operations management, enterprise project management, professional services, and software consulting services. We help our clients increase operational efficiency by delivering innovative solutions to solve their most complex business challenges.

Our approach is and has always been simple. First, think and act like the customers who need us, and most importantly, deliver what larger organizations cannot do - provide tangible results that add immediate value, at a rate that cannot be beaten. Your success matters, and we know it.

That's Impresiv

  • Registered Nurse

    1 month ago

    Santa Fe, NM, United States Professional Case Management Full time

    Make a Difference on Your Own Schedule and Terms!Hiring Case Managers in New Mexico   Come join our growing team! A few of our perks:Create your own schedule!$40/hr. (including 100% of Hourly Wage Paid for All Drive Time) Our RN-Case Managers conduct in-home nursing visits for our clients. All our clients are former Nuclear Weapon's Workers with...

  • Registered Nurse

    4 weeks ago

    Santa Barbara, United States VNA Health Full time

    Job DescriptionJob DescriptionAbout Us:At VNA Health, our mission is to revolutionize healthcare through compassion and innovation, ensuring every individual's well-being is prioritized. We're dedicated to empowering our employees to make a real difference in the lives of our patients and communities, driving positive change in healthcare. Join us in...

  • Case Management Nurse

    2 days ago

    Santa Barbara, United States BrightStar Care of Santa Barbara County Full time

    We are seeking an experienced RN Case Manager (CM) to be responsible for home health agency case management. The CM is a dedicated individual who shares our common values such as serving with a passion and doing the right thing. The CM will provide excellent customer service to patients, physicians, pharmacies, facilities, nurses, and ensures that the...

  • Case Manager

    6 days ago

    Santa Barbara, United States University of California, Santa Barbara Full time

    **Job Code**:4564 **Job Open Date**:4/23/2024 **Application Review Begins**: 5/8/2024 **Department Code (Name)**: SMHC (Student Mental Health Coordination) **Percentage of Time**: 100% **Union Code (Name)**: 99 - Non-Represented **Employee Class (Appointment Type)**: 1 - Staff: Contract **FLSA Status**:Exempt **Classified Indicator Description...

  • Service Coordinator

    5 hours ago

    Santa Barbara, United States Crestwood Behavioral Health Full time

    Title: Service Coordinator (Mental Health Case Manager) Job Duties: The Service Coordinator (Mental Health Case Manager) assesses clients to identify individual problem areas necessitating treatment and complete assessments. The Service Coordinator (Mental Health Case Manager) also coordinates the interdisciplinary team meetings and discharge planning...

  • Service Coordinator

    5 days ago

    Santa Barbara, United States Crestwood Behavioral Health Full time

    Are you looking for a meaningful role in behavioral health and have the desire to work with an organization that puts people first? If you have a passion for helping others along their recovery journey, then we invite you to join our Crestwood family! **For more than 50+ years** Crestwood has been committed to creating innovative recovery programs and...

  • Case Manager

    1 day ago

    Santa Barbara, United States Salvation Army Full time

    Mission Statement The Salvation Army, an international movement, is an evangelical part of the universal Christian church. Its message is based on the Bible. Its ministry is motivated by the love of God. Its mission is to preach the gospel of Jesus Christ and to meet human needs in His name without discrimination. Position Summary The Case Manager works...

  • Case Manager

    2 days ago

    Santa Barbara, United States The Salvation Army USA Western Territory Full time

    Description Mission Statement The Salvation Army, an international movement, is an evangelical part of the universal Christian church. Its message is based on the Bible. Its ministry is motivated by the love of God. Its mission is to preach the gospel of Jesus Christ and to meet human needs in His name without discrimination. Position Summary The Case...

  • Hospice RN Case Manager

    2 days ago

    Santa Fe, United States Enchanted Sky Hospice LLC Full time

    Job DescriptionJob DescriptionWe are seeking a full-time RN Case Manager who would like to join our hospice team!Job Description:RN Case Manager, M-F, DayshiftCreate your own visit schedule and have work/life balance.As a full-time RN case manager, you will manage a caseload of 10-15 patients.As a hospice nurse, you will provide patients and families...

  • Registered Nurse

    2 weeks ago

    Santa Barbara, CA, United States VNA Health Full time

    About Us:At VNA Health, our mission is to revolutionize healthcare through compassion and innovation, ensuring every individual's well-being is prioritized. We're dedicated to empowering our employees to make a real difference in the lives of our patients and communities, driving positive change in healthcare. Join us in our mission to provide exceptional...

  • Registered Nurse

    2 weeks ago

    Santa Barbara, CA, United States VNA Health Full time

    About Us:At VNA Health, our mission is to revolutionize healthcare through compassion and innovation, ensuring every individual's well-being is prioritized. We're dedicated to empowering our employees to make a real difference in the lives of our patients and communities, driving positive change in healthcare. Join us in our mission to provide exceptional...

  • Case ManagerOffice Assistant

    6 hours ago

    Santa Barbara, United States Council on Alcoholism and Drug Abuse Full time

    Benefits: 401(k) Dental insurance Health insurance Paid time off Vision insurance CADA (The Council on Alcoholism and Drug Abuse) is seeking a motivated individual to support our clients and staff at our adolescent substance abuse treatment program in Santa Maria. As an important member of our team, the Case Manager/Office Assistant interacts with our...

  • Medical Case Manager

    13 hours ago

    Santa Rosa, United States Pivotal Placement Services, Inc Full time

    Field Nurse Case ManagerWe are seeking a field case manager with a growing Case Management Company. This permanent full-time opportunity allows the nurse much more autonomy with their caseload with the ability to bonus. We are looking for highly skilled, self-motivated, registered nurses (RN) with experience with workers’ compensation nurse case...

  • RN Case Manager Home Health-Galveston

    1 week ago

    Santa Fe, TX, United States Interim Healthcare - Houston Full time

    Interim HealthCare, one of the nation’s leading providers of home care, is now seeking an RN Case Manager in the  Galveston area to join the team. Benefits at Interim Healthcare for Case Managers Competent and reliable in- office clinical support team. Weekly pay. Responsibilities of the Home Health Registered Nurse (RN) Case Manager include: ...

  • Case Manager, MSW

    1 day ago

    Santa Barbara, United States PATH (People Assisting the Homeless) Full time

    Job DescriptionJob DescriptionWHY WORK FOR US?We are mission and values driven and your contributions will make a difference. We make a positive difference in people's lives and help an average of 23 people per week to find a place to live.If you join us, you will be able to advocate for change while also working with influential people who effect...

  • RN / Case Management / California / Full Time / Case Manager Job

    7 days ago

    Santa Rosa, United States Tribal Health Full time

    Sonoma County Indian Health 144 Stony Point Road Santa Rosa, California Specialty: Family Practice / Case Manager, RN Schedule: Monday - Friday 8am-5pm; 32-40 hours per week Patient Volume: 12-15 per day; All ages Pay Rate: Discuss with Recruiter BLS; CA state license preferredFamiliar with CPSP- comprehensive perinatal service program

  • Case Manager

    1 day ago

    Santa Fe, New Mexico, United States Santa Fe Recovery Center Full time

    :Santa Fe Recovery Center is searching for a dynamic and motivated Case Manager for our Detox Program in our Santa Fe Offices. Qualified candidates should have previous case management experience and certification (CPSW).The SFRC Detox Program provides a foundational level of care for individuals who seek sobriety and recovery from substance use. SFRC...

  • Case Manager

    1 day ago

    Santa Fe, New Mexico, United States Santa Fe Recovery Center Full time

    :Santa Fe Recovery Center is searching for a dynamic and motivated Case Manager for our Detox Program in our Santa Fe Offices. Qualified candidates should have previous case management experience and certification (CPSW).The SFRC Detox Program provides a foundational level of care for individuals who seek sobriety and recovery from substance use. SFRC...

  • Santa Barbara PATH Street Outreach Case Manager

    2 days ago

    Santa Barbara, United States People Assisting The Homeless Full time

    Exempt Driving Required PATH is seeking candidates passionate about helping others make a positive change in their lives to join our Housing team as the Case Manager at our Santa Barbara office. ABOUT PATH Since its foundation in 4, PATH (People Assisting The Homeless) has pioneered bold and effective approaches to assist people experiencing...

  • Case Manager, HUGS Case Management/ Per Diem

    6 days ago

    Santa Fe, United States CHRISTUS Health Full time

    DescriptionPOSITION SUMMARY:  In collaboration with the patient/family, physicians and interdisciplinary team, the Case Management Coordinator ensures patient progression through the continuum of care in an efficient and cost effective manner. The Case Management Coordinator is responsible for identifying, initiating and managing optimal patient...