Care Manager

Job Tittle: Care Manager

Location: Remote

Duration: 3 Months (Possible Extensions)

Shift: 8AM 5PM (MonFri) (PST Time Zone)

Note Remote Anywhere in US Work in PST Time Zone but MUST CA RN License in addition to compact.

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.

Walk me through the daytoday responsibilities of this the role and a description of the project (Outside of Workday JD):

• Experience Working with Medicare/Medicaid
• Assisting with Backlogreferrals from CAmembers sending referrals to case managers
• Will be Assigned 510 referrals daily.
• Ability to work in Fast paced environment.
• Case Management exp required.
• At least four 5 hours a day are spent on outbound phone calls reaching out to members.
• Calls are recordedwill have audio audits.
• Data entrytracking data
• Case load requirement is 75(will be ramped up to this amt)
• Excel (data entrybasic knowledge)
• True Care medical records system
• Must be able to navigate multiple systems.
• Pharmacy system eligibility system Workforce management
• Engaged in Teams in Teams with
• Coordinate with Medicaid case managers.
• Initiativetaker and initiativetaking
• Develop assess and adjust as necessary the care plan and promote desired outcome.
• Assess the members current health status resource utilization past and present treatment plan and services prognosis short and longterm goals treatment and provider options.
• Coordinate services between Primary Care Physician (PCP) specialists medical providers and nonmedical staff as necessary to meet the complete medical socioeconomic needs of clients.
• Develop plan of care based upon assessment with specific objectives goals and interventions designed to meet members needs.
• Provide patient and provider education.
• Facilitate members access to communitybased services.
• Monitor referrals made to communitybased 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.
• Monitor referrals made to communitybased 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 treatment and provider options.
• Coordinate services between Primary Care Physician (PCP) specialists medical providers and nonmedical staff as necessary to meet the complete medical socioeconomic needs of clients.
• Develop plan of care based upon assessment with specific objectives goals and interventions designed to meet members needs.
• Provide patient and provider education.
• Facilitate members access to communitybased services.
• Monitor referrals made to communitybased 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.

Education/Experience:

• Graduate from an Accredited School of Nursing. Bachelors degree in Nursing preferred. 2 years of clinical nursing experience in a clinical acute care or community setting. Knowledge of healthcare and managed care preferred.
• Licenses/Certifications: Current states RN license.
• Describe the performance expectations/metrics for this individual and their team:
• Calls are audio recorded and must have seventyfive cases at a time.

What previous job titles or background work will be in this role

• Case Manager Transitions of Care Utilization Management Disease Management
• 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 members current health status resource utilization past and present treatment plan and services prognosis short and longterm goals treatment and provider options.
• Coordinate services between Primary Care Physician (PCP) specialists medical providers and nonmedical staff as necessary to meet the complete medical socioeconomic needs of clients.
• Develop plan of care based upon assessment with specific objectives goals and interventions designed to meet members needs.
• Provide patient and provider education.
• Facilitate members access to communitybased services.
• Monitor referrals made to communitybased 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.
• Education/Experience:
• Graduate from an Accredited School of Nursing.
• Knowledge of healthcare and managed care preferred.
• Prior experience working in a remote role preferred.
• Prior case management experience preferred and Bilingual in Spanish and English is preferred.