Care Manager, RN - Health Access, ECM

Exercise independent clinical judgment and strategic planning in managing a caseload of members with medical needs according to department processes and procedures. Recommend care coordination strategies for members, including but not limited to: Utilize clinical tools and metrics (i.e., brief medical interventions) as necessary to inform interventions, manage caseloads, and upscale high‑risk cases appropriately. Engage with members, both in‑person and on the phone, in a manner that utilizes evidence‑based approaches (such as Motivational Interviewing) that promotes collaboration between the member and his or her medical/behavioral team, as well as improving the member’s ability to manage and control their whole health. Conduct comprehensive, holistic assessment according to the scope of the RN license. Assimilate assessment information into an individualized care plan (ICP), communicate ICP with members, approved family or caregiver, and other members of the care team. Lead inter/transdisciplinary care team meetings to share information, update and inform care plan. Coordinate with internal and external health partners to support Members comprehensive care needs. Participate and lead care transition plan responsibilities. Assist with the coordination of medical and behavioral health access issues with PCP offices, specialists, and ancillary services. Coordinate care for members with complex medical and social needs, including across the physical, behavioral, and dental health delivery systems. Provide formal and informal training and support for Health Access Team Members on medical conditions, including treatments and evidence‑based for treatment. Provide clinical consultation and support for Health Access ECM Team Members on physical health conditions, including evidence‑based care. Represent the Enhanced Care Management team as the lead member when necessary. Develop interventions to improve the member’s ability to manage their own health. Support the clinical scope of responsibilities for non‑clinically licensed care Team Members within the RN scope of practice. Cultivate and sustain productive partnerships with providers, team members, and community stakeholders. Employ advanced communication methods to strengthen collaboration across in‑person, telephonic, and digital platforms. Model supportive and collaborative relationships with Members, co‑workers, and community relations. Promote a collaborative and effective working environment within the Health Access Enhanced Care Management team by engaging in evidenced‑based communication strategies (such as Motivational Interviewing) when discussing responsibility/sharing of tasks, effectively resolving conflicts as arise, and collaborating on Member case discussions. Model the highest ethical behavior in relationships with co‑workers, supervisors, Members, Providers, and colleagues in the community. Model commitment to continuous quality improvement by engaging in quality improvement initiatives and projects, such as identifying and addressing performance indicator measures, HEDIS gaps, and other quality measures. Participate in staff meetings, trainings, committee meetings, or other activities as needed or as directed by Leadership. Ensure documentation is accurate and in compliance with regulatory requirements and accreditation standards. Perform any other duties as required to ensure Health Plan operations and department business needs are successful. Requirements Three (3) or more years of care management experience in a health care delivery setting required. Experience working successfully within a team, and experience in developing and maintaining effective relationships with both clients and coworkers is mandatory. Experience in a Managed Care setting preferred. Minimum of one (1) year clinical experience in an acute care facility, skilled nursing facility, home health or clinic setting preferred. Associate’s degree in Nursing from an accredited institution required. Bachelor’s degree in Nursing from an accredited institution preferred. Possession of an active, unrestricted, and unencumbered Registered Nurse (RN) license issued by the California BRN required. Certified Case Manager (CCM) preferred. Must have a valid California Driver’s license and valid automobile insurance. Must qualify and maintain driving record to drive company vehicles based on IEHP insurance standards of no more than three (3) points. Bilingual (English/ “Target Language”) preferred. Hard Skills Clinical Assessment Care Coordination Evidence‑Based Interventions Quality Improvement Initiatives Documentation Compliance Soft Skills Collaboration Communication Relationship Building Conflict Resolution Team Leadership Certifications & Qualification Registered Nurse (RN) Certified Case Manager (CCM) #J-18808-Ljbffr Jobtailor