Job Summary:The RN Case Manager oversees comprehensive care coordination for diverse patient cases, utilizing effective communication strategies and cultural sensitivity to engage members and providers. With a focus on chronic conditions, mental health, and homelessness, they assess, develop, and implement care plans while ensuring regulatory compliance and compassionate patient support.
Supervisory Responsibilities: - Supervise the care management staff, including assisting in the development, training, network development, and assignment of work/projects.
- Supervises and evaluates appropriateness of care coordination and directs the case management staff to modify plans as needed.
Duties/Responsibilities: - Utilize medical interventions to enhance members' self-management of health.
- Engage with ECM Lead Care Managers via phone or in-person for assessment and care plan development.
- Provide training for ECM Team Members on medical conditions and treatments.
- Coordinate with internal and external partners to support members' comprehensive care.
- Coordinate clinical care for ECM Program clients and establish care plan goals.
- Organize and monitor services needed by recipients.
- Perform bio-psycho-social assessments and develop care plans.
- Oversee care plan implementation and monitor treatment adherence.
- Provide coaching for behavior change and health improvement.
- Document interactions and interventions accurately.
- Collaborate with executives and assist in staff training for safety and quality assurance.
- Design and execute training programs for Lead Care Managers.
- Prepare formal responses and reports for regulatory agencies.
- Establish effective processes and ensure compliance with regulations.
- Assist in maintaining operational efficiency and quality care for patients.
- Performs other duties as assigned.
Education and Experience: - Registered Nurse with a valid CA license from an accredited nursing school.
- Associate degree in Nursing from an accredited institution required.
- Bachelor's degree in nursing from an accredited institution preferred. Experience in a Health Care Organization or experience in Managed Care setting preferred.
- 1-2 years of case management experience with low-income populations, focusing on complex chronic conditions, mental illness, and homelessness.
- 2 years of experience with homeless, low-income, and mentally ill populations, including substance abuse.
- Experience in Medicare and Medi-Cal environments preferred.
Required Skills/Abilities: - Proficient in evidenced-based communication techniques like Motivational Interviewing.
- Understanding and sensitivity to multicultural communities.
- Knowledgeable in self-management practices for chronic conditions.
- Skilled in phone-based engagement with members and providers.
- Proficiency in data interpretation and learning new software systems.
- Strong attention to detail, analytical thinking, and interpersonal skills.
- Ability to work autonomously and as part of a team.
- Exceptional organizational and time management abilities.
- Compassionate and empathetic approach to patient care.
- Ability to analyze situations and act ethically and in compliance with regulations.
- Flexibility to adapt to changing environments
Physical Requirements: - Willingness to travel to different locations.
- Prolonged periods sitting at a desk and working on a computer.
- Must be able to lift up to 10 pounds at times.
Pay range
$90,000-$100,000 USD
BenefitsOur full-time employees are eligible for the following benefits enrollment after 60 days of employment:
Medical, Dental, & Vision Benefits: We have various insurance options for you and your family.
Short & Long-Term Disability Benefits: Protection when you need it most.
Voluntary Accident, Voluntary Critical Illness, and Voluntary Hospital Indemnity Plans: Added security for you and your loved ones.
Flexible Spending Accounts: Manage your finances with flexibility.
Employee Assistance Program (EAP): Support when life throws challenges your way.
401(K): Building your financial future with us. Effective after 1 year of employment.
Paid Vacation and Sick Leave: Flexibility for the planned and unplanned.
Paid Holidays: Quality time to enjoy celebrations.
Employee Referral Program: Share the opportunities and reap the rewards.
Company Discount Program: Enjoy savings on everyday expenses and memberships.
