Care Manager I RN

Job Description:

Job Tittle: Care Manager I

Location: Remote

Duration: 3 Months (Possible Extensions)

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

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.

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

Walk me through the day to day 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 4 5 hours a day is spent on outbound phone callsreaching 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
• Self starter and proactive

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 long term 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 socio economic 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 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 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 treatment and provider options
Coordinate services between Primary Care Physician (PCP) specialists medical providers and nonmedical 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 members 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

Education/Experience:

Graduate from an Accredited School of Nursing. Bachelors degree in Nursing preferred. 2 years of clinical nursing experience in an 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 75 cases at a time.
• What previous job titles or background work will 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.