Medical Case Manager RN Long Term Care
Medical Case Manager RN Long Term Care
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5years
Not Disclosed
Salary Not Disclosed
1 Vacancy
Job Description
Medical Case Manager RN Long Term Care
Company Overview: Our client is a leading healthcare located in Orange CA seeking a medical case manager for the longterm care department where they utilize advanced specialty collaborative practice responsible for case management care coordination authorization and utilization management of the assigned population of focus
Position Summary: The successful candidate should hold a current unrestricted registered nurse (RN) license to practice in the state of California holds a bachelor s degree in nursing and has 3 years of clinical experience.
Work Duration: Up to 6 months
Work hours: 8 am 5 pm MF
Position Responsibilities:
- Utilize case management processes including assessment care planning implementation and monitoring to support member health.
- Conduct and review clinical assessments using standardized tools (e.g. PASRR MDS CEDT HRA).
- Collaborate with hospitals on discharge planning participate in rounds and coordinate with CalAIM providers for community support services.
- Document case activities accurately and ensure timely data entry for authorizations and care updates.
- Review service requests against medical criteria and regulatory guidelines escalating complex cases to the Medical Director as needed.
- Engage with patients families and physicians to assess care needs and explain CalAIM and case management resources.
- Identify highcost complex cases for intensive case management and perform regular progress assessments to optimize care plans.
- Develop and oversee member care plans with input from the interdisciplinary team adapting as necessary to improve outcomes.
- Communicate with CalAIM providers community agencies and other partners to coordinate comprehensive patient care.
- Advocate for member needs including securing resources alternative treatments and timely care delivery.
- Document case decisions and actions in the medical management system and evaluate progress toward case management goals.
- Participates in hospital rounds.
- Complete additional assignments and projects as assigned.
Experience & Education:
Current unrestricted RN license to practice in the state of California required.
Bachelor s degree in nursing (BSN) required
3 years of clinical experience with the health needs of the population served required.
2 years of experience in Long Term Care Community Health Managed Care MediCal Medicare programs highly preferred
Active Commission for Case Manager (CCM) certification preferred
Necessary Attributes:
- Establish effective relationships with internal and external stakeholders.
- Demonstrate independent judgment and decisionmaking skills.
- Communicate effectively both verbally and in writing.
- Flexible schedule availability for evening and weekend events.
- Strong organizational analytical and problemsolving abilities.
- Proficiency in Microsoft Office (Word Outlook Excel PowerPoint) and jobspecific applications/systems.
Please see HR for information on physical demands and work environment of this job.
Sunshine Enterprise USA is an Equal Opportunity Employer Minorities Females Veterans and Disabled Persons
Bachelor s degree PLUS 2 years of experience in facilities management or property management required; an equivalent combination of education and experience sufficient to successfully perform the essential duties of the position such as those listed above may also be qualifying. 2 years of experience as an administrative assistant.
Education
Bachelor s degree PLUS 2 years of experience in facilities management or property management required; an equivalent combination of education and experience sufficient to successfully perform the essential duties of the position such as those listed above may also be qualifying. 2 years of experience as an administrative assistant.
Employment Type
Full Time
