Job Description
POSITION PURPOSE

The Care Manager is responsible for working directly with the Plan, IPA medical groups, providers, hospitals, community agencies, Members/caregivers, and other entities supporting clientcare to ensure coordinated, continuous care and serve as a resource person to these facilities. The RN Care Manager supports the care team, finalizes the care management assessment and Individualized Care Plan (ICP).

Responsibilities

1. Responsible for serving as a resource for Clients and Providers for care management and continuity of care.

1. Responsible for assessing clients for appropriate care management needs including:

• Conducting a clinical assessment and medication reconciliation.
• Develop, implement, and evaluate Individualized Care Plans (ICP)
• Act as a Member advocate
• Serve as a liaison between clients, caregivers, and providers
• Educate and support clients/caregivers with meeting ICP goals
• Identify need for Interdisciplinary Care Team (ICT), organize the participants to be included and ensure facilitation and documentation of the ICT.

3. Review and revise contributions to assessment information and care planning from care team members (i.e. LVN

Care Manager, Care Coordinator) as appropriate.

4. Assist with referrals for clients that are eligible for carve out programs such as CCS, multi-organ transplant,

etc.

5. Assist clients with immediate needs with regard to access, referrals and authorizations.

6. Assist clients with resources such as LTSS, Independent Living and Diversity Services, Behavioral Health, and

Community Resources.

7. Responsible for any other duties as required ensuring successful care management processes and Member

outcomes using critical thinking and innovative techniques to engage and retain Members in the CM program.

8. Any other duties as required or assigned to ensure Health Plan operations are successful.

Requirements

Education/License:

Valid, unrestricted RN license issued by the State of California Possession of a valid State of California driver's license.

Experience:

Minimum 2 years clinical experience in an acute care facility, skilled nursing facility, home health or clinic setting. Two ( 2) or more years of care management experience in a health care delivery setting preferred. Experience in a Managed Care (HMO, IPA) or in acute facility (i.e. hospital) care management preferred.

Benefits

Excellent package inclusive of a pension and annual merit increases.