In this role, the selected candidate will work collaboratively with an assigned panel of physicians to manage the patient's specialized needs; identify member needs and development of specific care management plan to address needs.
The incumbent will be responsible for the day-to-day management of the Medi-Cal Complex Case Management Program, including overview of targeted members, management of the nurses and staff in the unit, interface with local medical centers and physicians, and monitoring and evaluation of program outcomes achieved.
In this role, the selected candidate will collaborate with physicians, other members of the multidisciplinary health care team & patient/family in the development, implementation & documentation of appropriate, individualized plans of care to ensure continuity, quality & appropriate resource use.
The Case Manager has an understanding of current CMS compliance regulations. Applies standardized and approved criteria for medical necessity or need to admit and level of care and documents its application. Defines a working length of stay based on admission diagnosis.