Medical Case Manager RN
Medical Case Manager RN
Posted on :
11-01-2025
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1 Vacancy
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Monthly Salary
Not Disclosed
Salary Not Disclosed
Vacancy
1 Vacancy
Posted on :
11-01-2025
Job Description
Client: CalOptima Health
Job Title: Medical Case Manager
Duration: 06 Months
Start Date: ASAP
Location: 505 City Parkway West Orange CA 92868 (Onsite)
Position Type: Contract
Interview Type: Web Interview
Job Title: Medical Case Manager
Duration: 06 Months
Start Date: ASAP
Location: 505 City Parkway West Orange CA 92868 (Onsite)
Position Type: Contract
Interview Type: Web Interview
Working Hours: 40 Hours a Week Monday to Friday Full InOffice (8am to 5pm)
Ceipal ID: CALHD439IK
Position ID: 439
Ceipal ID: CALHD439IK
Position ID: 439
Department: Case Management
Description:
- CalOptima Health is seeking a highly motivated an experienced TEMP Medical Case Manager to join our team.
- Case Management is an advanced specialty collaborative practice responsible for providing ongoing case management services for CalOptima Healths members.
- The Medical Case Manager will facilitate communication and coordination among all participants of the health care team and CalOptima Healths members to ensure the services provided promote quality and costeffective outcomes for all members. The incumbent will be responsible for providing intensive case management which includes assessment planning implementation coordination monitoring and evaluation of the members needs.
Duties & Responsibilities:
85% Care Management
- Assesses member needs using a standardized health needs assessment or health risk assessment.
- Performs comprehensive disease specific clinical assessments of all identified cases which includes but is not limited to assessment of: Members physical functional social and psychological status Members cultural and linguistic needs Caregiver resources and available benefits
- Performs postdischarge assessments to identify members posthospital or postemergency department 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 Specific Measurable Achievable Relevant and TimeBound (SMART) goals.
- Reviews modifies and updates care plans continuously to reflect the members needs at minimum annually or upon change in condition. Schedules followups to assess progress towards goals and identifies barriers to meeting goal.
- Provides regular outreach to assigned members along with 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 LongTerm Services and Supports (LTSS). 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 LTSS department community supports and community resources. Facilitates and participates in Interdisciplinary Team meetings as applicable.
- Collaborates with interdepartmental staff in case resolution as needed. Identifies cases needing supervisor manager director or medical director review or input routes accordingly and closes cases according to procedures and guidelines in a timely manner. Advocates in the members best interest for necessary funding treatment alternatives timelines and coordination of care and frequent evaluations of progress and goals.
- Assesses member needs using a standardized health needs assessment or health risk assessment.
- Performs comprehensive disease specific clinical assessments of all identified cases which includes but is not limited to assessment of: Members physical functional social and psychological status Members cultural and linguistic needs Caregiver resources and available benefits
- Members physical functional social and psychological status
- Members cultural and linguistic needs
- Caregiver resources and available benefits
- Performs postdischarge assessments to identify members posthospital or postemergency department 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
- 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 Specific Measurable Achievable Relevant and TimeBound (SMART) goals.
- Reviews modifies and updates care plans continuously to reflect the members needs at minimum annually or upon change in condition.
- Schedules followups to assess progress towards goals and identifies barriers to meeting goal. Provides regular outreach to assigned members along with 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 LongTerm Services and Supports (LTSS).
- 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 LTSS department community supports and community resources.
- Facilitates and participates in Interdisciplinary Team meetings as applicable.
- Collaborates with interdepartmental staff in case resolution as needed.
- Identifies cases needing supervisor manager director or medical director review or input routes accordingly and closes cases according to procedures and guidelines in a timely manner.
- Advocates in the members best interest for necessary funding treatment alternatives timelines and coordination of care and frequent evaluations of progress and goals.
10% Administrative Support
- 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. Prepares and maintains appropriate documentation of patient care and progress within the care plan.
- 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.
- Prepares and maintains appropriate documentation of patient care and progress within the care plan.
5% Completes other projects and duties as assigned.
Minimum Qualifications:
- Associate degree in nursing (ADN) or related field required PLUS 3 years of clinical experience and/or managed care experience 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.
Preferred Qualifications:
- Bachelor of Science in Nursing (BSN) degree or related field.
- Case Management Certification (CCM).
- Bilingual in English and one of CalOptima Healths defined threshold languages (Arabic Chinese Farsi Korean Spanish Vietnamese).
Required Licensure / Certifications:
- Current unrestricted Registered Nurse (RN) license to practice in the state of California required.
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
Work Environment:
- If located at the 500 505 Building or a remote work location:
- Work is typically indoors and sedentary and is subject to schedule changes and/or variable work hours with travel as needed.
- There are no harmful environmental conditions present for this job.
- The noise level in this work environment is usually moderate.
If located at PACE:
- Work is typically indoors in a clinical setting serving the frail and elderly.
- There may be harmful or hazardous environmental conditions present for this job.
- The noise level in this work environment is usually moderate to loud.
If located in the Community:
- Work is typically indoors and sedentary and is subject to schedule changes and/or variable work hours with travel as needed.
- Employee will occasionally work outdoors in varied temperatures.
- There may be harmful or hazardous environmental conditions present for this job.
- The noise level in this work environment is usually moderate to loud
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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Employment Type
Full Time
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