Healthcare - Case Manager III

Healthcare - Case Manager III

Location: San Diego area (CA State)

Duration: 3+ Months

Shift Timing: Monday through Friday, 8:30AM to 5:30PM PST

Pay Range: $45.00 - $47.26

Job Description

This role will be remote, but there may be times the case manager may need to work in the office or make visits to see members in-person. It's very minimal at this time, but could happen.

The expected schedule is Monday through Friday, 8:30AM to 5:30PM PST.

Day to day job duties include outreach to members assigned to them, completing various assessments, creating individualized care plans, and assisting members with community resources/linkages.

Top Skills Required

Strong computer skills as this job requires being able to navigate different systems; organization as there is a lot of work and very independent; health literacy – as this position is for a case manager so they will need to be able to assess/understand different physical and mental health diagnoses/symptoms and educate members.

Required Education/Certification(s)

RN

Required Years of Experience

Prefer 3, but open to someone with less years, depending on what work they have been doing

Extra Equipment Required

Dual monitors, docking station

Potential for Extension

There is potential to convert to FTE

Responsibilities

Responsible for health care management and coordination of Client Healthcare members in order to achieve optimal clinical, financial and quality of life outcomes. Works with members to create and implement an integrated collaborative plan of care.

Coordinates and monitors Clientmember's progress and services to ensure consistent cost effective care that complies with Client policy and all state and federal regulations and guidelines.

Provides case management services to members with chronic or complex conditions including.

Proactively identifies members that may qualify for potential case management services.

Conducts assessment of member needs by collecting in-depth information from Client information system, the member, member's family/caregiver, hospital staff, physicians and other providers. Identifies, assesses and manages members per established criteria.

Develops and implements a case management plan in collaboration with the member, caregiver, physician and/or other appropriate healthcare professionals to address the member needs. Performs ongoing monitoring of the plan of care to evaluate effectiveness.

Documents care plan progress in Client information system. Evaluates effectiveness of the care plan and modifies as appropriate to reach optimal outcomes. Measures the effectiveness of interventions to determine case management outcomes.

Promotes integration of services for members including behavioral health and long term care to enhance the continuity of care for Client members. Conducts face to face or home visits as required.

Maintains department productivity and quality measures.

Manages and completes assigned work plan objectives and projects in a timely manner.

Demonstrates dependability and reliability. Maintains effective team member relations. Adheres to all documentation guidelines.

Participates in Interdisciplinary Care Team (ICT) meetings.

Assists orientation and mentoring of new team members as appropriate.

Maintains professional relationships with provider community and internal and external customers.

Conducts self in a professional manner at all times.

Maintains cooperative and effective workplace relationships and adheres to company Code of Conduct. Participates in appropriate case management conferences to continue to enhance skills/abilities and promote professional growth. Complies with required workplace safety standards.

Knowledge/Skills/Abilities

Demonstrated ability to communicate, problem solve, and work effectively with people.

Excellent organizational skill with the ability to manage multiple priorities. Work independently and handle multiple projects simultaneously.

Knowledge of applicable state, and federal regulations.

Knowledge of ICD-9, CPT coding and HCPC. SSI, Coordination of benefits, and Third Party Liability programs and integration.

Familiarity with NCQA standards, state/federal regulations and measurement techniques.

In depth knowledge of CCA and/or other Case Management tools. Ability to take initiative and see tasks to completion. Computer skills and experience with Microsoft Office Products.

Excellent verbal and written communication skills. Ability to abide by Client policies. Able to maintain regular attendance based upon agreed schedule.

Maintain confidentiality and comply with Health Insurance Portability and Accountability Act (HIPAA).

Skilled at establishing and maintaining positive and effective work relationships with coworkers, clients, members, providers and customers.

Required Education

Bachelor's degree in Nursing or Masters degree in Social Work, or Health Education (a combination of experience and education will be considered in lieu of degree).

Required Experience

5-7 years of clinical experience with case management experience.