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. Responsiblefor serving as a resource for Clients and Providers for caremanagement and continuity of care.

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

• Conductinga clinical assessment and medication reconciliation.
• Develop,implement, and evaluate Individualized Care Plans (ICP)
• Actas a Member advocate
• Serveas a liaison between clients, caregivers, and providers
• Educateand support clients/caregivers with meeting ICP goals
• Identifyneed for Interdisciplinary Care Team (ICT), organize the participants tobe 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 CaliforniaPossession of a valid State of California driver's license.

Experience:

Minimum 2 yearsclinical experience in an acute care facility, skilled nursing facility, homehealth or clinic setting. Two( 2) or more years of care managementexperience in a health care delivery setting preferred.Experience in aManaged Care (HMO, IPA) or in acute facility (i.e. hospital) care managementpreferred.

Benefits

Excellent package inclusive of a pension and annual merit increases.