MUST HAVE Current, unrestricted Registered Nurse (RN) license to practice in the state of California required. MUST HAVE Associate degree in nursing (ADN) or related field required PLUS 3 years of clinical experience and/or managed care experience required. Job Summary CalOptima Health is seeking a highly motivated an experienced TEMP - Medical Case Manager (Case Mgt) to join our team. Case Management is an advanced specialty collaborative practice, responsible for providing ongoing case management services for CalOptima Health's members. The Medical Case Manager will facilitate communication and coordination among all participants of the health care team and the member to ensure the services provided promote quality and cost-effective outcomes for all members along with focus on members under 21 years of age. The incumbent will be responsible for providing intensive case management primarily to a pediatric population, which includes assessment, planning, implementation, coordination, monitoring and evaluation of the member's needs. Position Information: Department: Case Management Salary Grade: 313 - $43.66 - $69.8615 Work Arrangement: Full Office Duties & Responsibilities: 85% - Care Management Assesses member needs using a standardized health needs assessment or health risk assessment. Performs comprehensive, disease specific, clinical assessments of all identified cases, which includes but is not limited to, assessment of: Member's physical, functional, social and psychological status Member's cultural and linguistic needs o Caregiver resources and available benefits Performs post-discharge assessments to identify member's post-hospital or post-emergency department discharge needs including but not limited to: Member's physical, functional, social and psychological status Member's cultural and linguistic needs o Caregiver resources and available benefits Follow-up provider care and ensuring scheduled appointments Durable medical equipment and supplies o Community resources Develops and implements a member's specific care plan which includes prioritized Specific, Measurable, Achievable, Relevant, and Time-Bound (SMART) goals. Reviews, modifies and updates care plans continuously to reflect the member's needs, at minimum, annually or upon change in condition. Schedules follow-ups to assess progress towards goals and identifies barriers to meeting goal. Provides regular outreach to assigned members along with members from a worklist and evaluates quality of service given to members according to department contact standards. Coordinates care and services with members, members' family members/representatives and other providers, as appropriate, including community supports and Long-Term Services and Supports (LTSS). Communicates with Member's physicians, specialists, community agencies and vendors to ensure coordination of services. Facilitates referrals to behavioral health/substance use disorder services and identifies and makes referrals to LTSS department, community supports and community resources. Facilitates and participates in Interdisciplinary Team meetings as applicable. Collaborates with interdepartmental staff in case resolution as needed. Identifies cases needing supervisor, manager, director or medical director review or input, routes accordingly and closes cases according to procedures and guidelines in a timely manner. Advocates in the member's best interest for necessary funding, treatment alternatives, timelines and coordination of care and frequent evaluations of progress and goals. 10% - Administrative Support Participates in a mission driven culture of high-quality performance, with a member focus on customer service, consistency, dignity and accountability. Assists the team in carrying out department responsibilities and collaborates with others to support short- and long-term goals/priorities for the department. Follows CalOptima Health's protocol for documenting all case interventions. Prepares and maintains appropriate documentation of patient care and progress within the care plan. 5% - Completes other projects and duties as assigned. Minimum Qualifications: Associate degree in nursing (ADN) or related field required PLUS 3 years of clinical experience and/or managed care experience required; an equivalent combination of education and experience sufficient to successfully perform the essential duties of the position such as those listed above may also be qualifying. Preferred Qualifications: Bachelor of Science in Nursing (BSN) degree or related field. 2 years of pediatric experience. Certified Case Manager (CCM) certificate. Bilingual in English and one of CalOptima Health's defined threshold languages (Arabic, Chinese, Farsi, Korean, Spanish, Vietnamese). Required Licensure / Certifications: Current, unrestricted Registered Nurse (RN) license to practice in the state of California required. Knowledge & Abilities: Develop rapport and establish and maintain effective working relationships with CalOptima Health's leadership and staff and external contacts at all levels and with diverse backgrounds. Work independently and exercise sound judgment. Communicate clearly and concisely, both orally and in writing. Work a flexible schedule; available to participate in evening and weekend events. Organize, be analytical, problem-solve and possess project management skills. Work in a fast-paced environment and in an efficient manner. Manage multiple projects and identify opportunities for internal and external collaboration. Motivate and lead multi-program teams and external committees/coalitions. Utilize computer and appropriate software (e.g., Microsoft Office: Word, Outlook, Excel, PowerPoint) and job specific applications/systems to produce correspondence, charts, spreadsheets, and/or other information applicable to the position assignment. Physical Requirements (With or Without Accommodations): Ability to visually read information from computer screens, forms and other printed materials and information. Ability to speak (enunciate) clearly in conversation and general communication. Hearing ability for verbal communication/conversation/responses via telephone, telephone systems, and face-to-face interactions. Manual dexterity for typing, writing, standing and reaching, flexibility, body movement for bending, crouching, walking, kneeling and prolonged sitting. Lifting and moving objects, patients and/or equipment 10 to 25 pounds Work Environment: If located at the 500, 505 Building or a remote work location: Work is typically indoors and sedentary and is subject to schedule changes and/or variable work hours, with travel as needed. There are no harmful environmental conditions present for this job. The noise level in this work environment is usually moderate. About CalOptima Health: CalOptima Health is the single largest health plan in Orange County, serving one in four residents. Our motto - "Better. Together." - is at the heart of our mission to serve members with excellence, dignity and respect. We are a public agency made up of compassionate leaders and professionals working together to strengthen our community's health. We are continuing to build a culture that promotes diversity and inclusion within our community where employees have a sense of belonging, and are valued for their ideas, contributions, and their unique individual perspectives they bring. CalOptima Health has been recognized as one of Orange County's best places to work, so we know there is something special about our organization. It is why people choose to work here and why they choose to stay! CalOptima Health is committed to attracting, hiring, and retaining a diverse staff, where we will honor your unique experiences, identity, and perspectives. Our organization strives to create and maintain a workplace environment that is inclusive, equitable and welcoming so we can truly be Better Together. CalOptima Health is an equal opportunity employer and makes all employment decisions on the basis of merit. CalOptima Health wants to have qualified employees in every job position. CalOptima Health prohibits unlawful discrimination against any employee, or applicant for employment, based on race, religion/religious creed, color, national origin, ancestry, mental or physical disability, medical condition, genetic information, marital status, sex, sex stereotype, gender, gender identity, gender expression, transitioning status, age, sexual orientation, immigration status, military status as a disabled veteran, or veteran of the Vietnam era, or any other consideration made unlawful by federal, state, or local laws. CalOptima Health also prohibits unlawful discrimination based on the perception that anyone has any of those characteristics or is associated with a person who has, or is perceived as having, any of those characteristics.
