Clinical Quality Nurse Manager- Remote- CA

Clinical Quality Nurse Manager- Remote- CA

Johnson Service Group (JSG) is seeking a Clinical Care Manager. Must Live in California- Remote Work Schedule: Monday-Friday 8am-5pm Pay Range: $47-$58.00 per hour

Job Description

The Clinical Care Manager will perform comprehensive assessments, develop individualized care planning, initiate, and coordinate interdisciplinary case conferences with providers of service, support members in creating and adhering to person-centered care plans. Additionally, the Clinical Case Manager will be coordinating services with other departments, providers, programs, and community partners, as needed, to provide support.

Essential Functions:

• Manage a panel of assigned members to guide along the continuum of care to the optimal functional level and quality of life.
• Conduct comprehensive assessments and annual or as needed re-assessments of the member's psychosocial, physical health, functional abilities, and social determinants of health.
• Develop an individualized care plan based on assessment information that is member-centered, comprehensive and consistent with program guidelines and policies and procedures.
• Identifies member's need for LTSS programs, Behavioral Health Services, community supports and other services to fill gaps in care, monitors effectiveness of services.
• Conducts outreach to member for care plan review, needs assessment and acuity monitoring.
• Establishes and maintains open and effective communication with physicians and other health care and social service workers. Provides appropriate information on all significant aspects of member's care and program operations, while maintaining necessary confidentiality.
• Maintains necessary and complete documentation for all case management activities in the plan's case management system, MedHOK.
• Leads and/or participates in clinical huddles and interdisciplinary care team meetings with internal company staff and external partners and providers.
• Make referrals to various company departments, community-based organizations, and governmental agencies when health and/or psychosocial condition(s) indicate need for appropriate referrals(s). Promotes clear communication amongst the care team, which can include family and community supports, and treating providers by ensuring awareness regarding member care plans, and when supporting care transitions.
• Teach appropriate interventions, link to resources, educate about benefits, and discuss medication effects and side effects to patient, caregiver, volunteers, and others as appropriate.
• Adhere to case management practice standards at all times.
• Participate in continuous quality improvement efforts.
• Maintain knowledge of company benefits, programs, and processes, in order to provide clear information to member and providers.
• Maintain knowledge of community resources and programs.
• Maintain working knowledge of confidentiality practices and standards. Adheres to all standards of confidentiality and patient health information.

Secondary Functions:

• Perform other necessary duties as assigned.

Qualifications:

Education and Experience:

• Bachelor or Associates degree.
• Two (2) years clinical experience.
• Three (3) years of managed care experience preferably in Care Coordination.
• Experience working with the health needs of the population served.
• At least one year of direct Care Coordination experience.
• Valid California license as a RN, LCSW, LMFT. PHN preferred. Will consider unlicensed Masters Level Social Worker (MSW/ASW).
• Certification as Certified Case Manager (CCM) preferred.

Knowledge:

• Personal computers and proficiency in Microsoft Office Suite applications, including Outlook, Word, Excel, Access, and PowerPoint.
• Case management principles and practices.
• Strong knowledge of Medicare and Medi-Cal programs and benefits.
• Advanced knowledge of community resources.
• Complexities of working with the elderly, vulnerable and disabled populations.
• Expanded knowledge of social determinants of health.
• Understanding and familiarity of care transitions and discharge planning.
• HIPAA and other applicable federal and state regulations for confidentiality.

Skills:

• Demonstrate member, provider and interdisciplinary team focused interpersonal skills.
• Work effectively with people in varying positions and diverse backgrounds, by maintaining cultural competency knowledge and practice.
• Communicate effectively through written, verbal and listening communication skills.
• Conflict resolution, assertiveness, and collaboration skills
• Bilingual skills highly preferred, particularly Spanish, Tagalog or Chinese.

Abilities:

• Adapt to changes in requirements/priorities for daily and specialized tasks.
• Work autonomously and be directly accountable for practice of case management.
• Work collaboratively with others.
• Work as part of a team and support team decisions. Utilize member-centric approach to care coordination.
• Function effectively in a fluid, dynamic, and rapidly changing environment.
• Influence and gain consensus on individual and group decision-making.

JSG offers medical, dental, vision, life insurance options, short-term disability, 401(k), weekly pay, and more. Johnson Service Group (JSG) is an Equal Opportunity Employer. JSG provides equal employment opportunities to all applicants and employees without regard to race, color, religion, sex, age, sexual orientation, gender identity, national origin, disability, marital status, protected veteran status, or any other characteristic protected by law.