CareManager

Description:

CalOptima Health is seeking a highly motivated an experienced TEMP Care Manager (2) to join our team. The Care Manager of Transitional Care Services (TCS) will facilitate communication and coordination among all participants of the health care team and the member to ensure the services provided promote quality and costeffective outcomes for members who have recently discharged from the hospital or emergency department (ED). The incumbent will be responsible for providing intensive case management which includes assessment planning implementation coordination monitoring and evaluation of the members needs

Department: Case Management

85% Care Management:

• Assesses member needs using a standardized health needs assessment or health risk assessment with member or members representative.
• Performs postdischarge assessment to identify members posthospital or postED discharge needs including but not limited to: Members physical functional social and psychological status Members cultural and linguistic needs Caregiver resources and available benefits
• Followup provider care and ensuring scheduled appointments Durable medical equipment and supplies Community resources Develops and implements a members specific care plan which includes prioritized SMART goals. Care plan will be continuously reviewed modified and updated to reflect the members needs.
• Schedules weekly followups with member or members representative to assess progress towards goals and identifies barriers to meeting goals.
• Provides regular outreach to assigned members along with assigned members from a worklist and evaluates quality of service given to members according to department contact standards.
• Coordinates care and services with members members family members/representatives and other providers as appropriate including Community Supports and LTSS.
• Conducts facetoface meetings at settings outside of CalOptima Healths locations such as in hospitals skilled nursing facilities longterm acute care hospitals recuperative care and in members home settings with members members family members/representatives and other providers as appropriate.
• Communicates with members physicians specialists community agencies and vendors to ensure coordination of services.
• Facilitates referrals to behavioral health/substance use disorder services and identifies and makes referrals to LongTerm Support Services (LTSS) department Community Supports and community resources.
• Facilitates and participates in Interdisciplinary Care Team meetings as applicable.
• Collaborates with interdepartmental staff in case resolution as needed.
• Identifies cases needing manager director or medical director review or input routes accordingly and closes cases according to procedures and guidelines in a timely manner.
• Prepares and maintains appropriate documentation of patient care and progress within the documentation platform or care plan as appropriate.
• Advocates in the members best interest for necessary funding treatment alternatives timelines and coordination of care and frequent evaluations of progress and goals.

• Participates in a mission driven culture of highquality performance with a member focus on customer service consistency dignity and accountability.
• Assists the team in carrying out department responsibilities and collaborates with others to support short and longterm goals/priorities for the department.
• Follows CalOptima Healths protocol for documenting all case interventions.
• Ensures reporting of productivity metrics to supervisor.

Knowledge & Abilities:

• Develop rapport and establish and maintain effective working relationships with CalOptima Healths leadership and staff and external contacts at all levels and with diverse backgrounds.
• Work independently and exercise sound judgment.
• Communicate clearly and concisely both orally and in writing.
• Work a flexible schedule; available to participate in evening and weekend events.
• Organize be analytical problemsolve and possess project management skills.
• Work in a fastpaced environment and in an efficient manner.
• Manage multiple projects and identify opportunities for internal and external collaboration.
• Motivate and lead multiprogram teams and external committees/coalitions.
• Utilize computer and appropriate software (e.g. Microsoft Office: Word Outlook Excel PowerPoint) and job specific applications/systems to produce correspondence charts spreadsheets and/or other information applicable to the position assignment.
• Physical Requirements (With or Without Accommodations): Ability to visually read information from computer screens forms and other printed materials and information. Ability to speak (enunciate) clearly in conversation and general communication.
• Hearing ability for verbal communication/conversation/responses via telephone telephone systems and facetoface interactions.
• Manual dexterity for typing writing standing and reaching flexibility body movement for bending crouching walking kneeling and prolonged sitting.
• Lifting and moving objects patients and/or equipment 10 to 25 pounds

Minimum Qualifications:

• Bachelors degree in social work psychology gerontology public health or social science required.
• 5 years of clinical experience and/or managed care experience required.
• Valid drivers license and vehicle or other approved means of transportation an acceptable driving record and current auto insurance will be required for work away from the primary office 20% of the time or more.

• Licensed Vocational Nurse Licensed Marriage and Family Therapist or masters degree in social work gerontology public health or related field.
• Experience with behavioral health or substance use case management.
• Certified Case Manager (CCM) certificate.
• Bilingual in English and one of CalOptima Healths defined threshold languages (Arabic Chinese Farsi Korean Spanish Vietnamese)

V Group Inc. is an IT Services company that supplies IT staffing project management and delivery services in software network help desk and all IT areas. Our primary focus is the public sector including state and federal contracts. We have multiple awards/ contracts with the following states: CA FL GA MD MI NC NY OH OR PA SC VA and WA CT TN. If you are considering applying for a position with V Group or partnering with us on a position please feel free to contact me with any questions you may have regarding our services and the advantages we can offer you as a consultant.

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