Description:

POSITION OVERVIEW Care Manager is responsible for managing low and moderate risk Special Needs Population (SNP) and Dual Eligible (DE) members.

Care Manager will ensure that the SNP and DE receive an assessment. Ensures the individualized care plan is developed and presented timely to the IDCT.

RESPONSIBILITIES AND FUNCTIONS

? Managers a case load of 400-600 low to moderate risk SNP and or CMC members. ? Coordinates and schedules all IDCT meetings ? Ensures all SNP and DE members are presented at IDCT at least annually ? .Facilitates Primary Care Provider attendance ? Ensures SNP and DE member and or caregiver participation ? Obtains the health plan HRA from various websites ? Oversees the low risk SNP and DE population and ensures the annual review of the care plan is completed for those members who did not have a change in health status. ? Manages all communication and information flow ? Completes the model of care training annually ? Works collaboratively with the patient, physician, family/significant other and providers of healthcare to implement plan of care to meet the individual needs. ? Works collaboratively with discharge planners at the affiliated hospitals and case management staff to identify changes in health status. ? Coordinates referrals to LTSS as indicated. ? Provides patients with education and training regarding specific health care needs. ? Monitors care, which is easily accessible with no access barriers as related to the patient’s available benefits. ? Facilitates early and intensive treatment intervention in the least restrictive setting. ? Facilitates the scheduling of follow up services as appropriate. ? Provides accurate and up-to-date information to practitioners regarding clinical practice guideline criteria and patient information. ? Creates individualized treatment plans that incorporate the HRA, community LTSS services ? Utilizes multidisciplinary clinical, rehabilitative and support services. ? Grants adequate attention to patient satisfaction through the evaluation and improvement of the care coordination process. ? Upholds strict rules of confidentiality. ? Provides ongoing Care coordination program analysis and development. ? Encourages collaborative collegial approaches to the Case Management process. ? Promote the Care coordination Program’s viability and accountability. ? Other duties as assigned Level of Education : Associates degree in Nursing or BSN preferred Professional Certification or License • Active RN or LVN license in the State of California • Valid California Driver’s license and insurance Level of Experience • A minimum of 2 years experience in managed care environment, preferably in an IPA or MSO. Other case management experience will be considered. Specific Knowledge, Skills, and Abilities • Knowledge of HMO UM and QM Processes. • Knowledge of and experience with the utilization of UM criteria such as Milliman & Robertson, Medicare and Medicaid guidelines, health plan criteria, etc. • General knowledge of IPA Operations • Familiar with various financial risk arrangements • Computer literate in Microsoft Word and Excel. • Strong verbal and written communication skills. • Knowledge of and experience with medical coding. • Strong ability to work effectively with physicians and other clinical and operational staff, both written and verbally. • Self motivated with strong organizational skills. • Ability to look at challenges as opportunities. • Flexible and adaptable of schedule to attend various meetings and/or promotional events. • Ability to read quickly with excellent comprehension and retention. Must need to know Outlook, MS Office

Hours are 8-5 with a 1 hour lunch or 8:30 – 5 with ½ hour lunch. Training hours about 1 week Interviewing - Face to Face

Please confirm the worksite location – location is 18 Centerpointe Drive, La Palma, CA 90623