Clinical - Care Manager I (RN)
2 months ago
SHIFT: 8am-5pm PST
Requirement: California Registered Nurse License
Job Description: Description - External
Position Purpose: Perform care management duties to assess, plan and coordinate all aspects of medical and supporting services across the continuum of care for select members to promote quality, cost effective care
" Develop, assess and adjust, as necessary, the care plan and promote desired outcome
" Assess the member's current health status, resource utilization, past and present treatment plan and services, prognosis, short and long term goals, treatment and provider options
" Coordinate services between Primary Care Physician (PCP), specialists, medical providers, and non-medical staff as necessary to meet the complete medical socio economic needs of clients
" Develop plan of care based upon assessment with specific objectives, goals and interventions designed to meet member's needs
" Provide patient and provider education
" Facilitate member access to community based services
" Monitor referrals made to community based organizations, medical care and other services to support the members overall care management plan
" Actively participate in integrated team care management rounds
" Identify related risk management quality concerns and report these scenarios to the appropriate resources
" Enter and maintain assessments, authorizations, and pertinent clinical information into various medical management systems
Qualifications - External
Education/Experience: Graduate from an Accredited School of Nursing. Bachelor s degree in Nursing preferred. 2+ years of pediatric clinical nursing experience in a clinical, acute care, or community setting. Knowledge of healthcare and managed care preferred. Florida residency required. Knowledge of healthcare and managed care preferred. Prior experience working in a remote role preferred. Prior case management experience preferred. Bilingual in Spanish and English is preferred.
Licenses/Certifications: Current state s RN license.
Walk me through the day to day responsibilities of this the role and a description of the project:
- Conducting comprehensive assessments of members health needs
- Developing personalized care plans based on members needs and input
- Providing member education
- Must have Ca RN license
- Making outbound calls and taking inbound calls -will spent most of their day on the phone reaching out to members
- Data Entry
- Must have strong computer skills
- Excellent time management skills.
- Navigating multiple systems
- Caseload target 75-80
- Case Duration 90 days
- Addressing 90% of Care Gaps.
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