Clinical Care Manager

Job Summary: The Clinical Care Manager will perform comprehensive assessments, develop individualized care planning, initiate and coordinate interdisciplinary case conferences with providers of service, and 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. Duties and Responsibilities: Manage a panel of assigned members to guide them along the continuum of care to the optimal functional level and quality of life. Conduct comprehensive assessments and annual or as-needed reassessments 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, policies, and procedures. Identifies members' need for LTSS programs, Behavioral Health Services, community supports, and other services to fill gaps in care, and monitors the effectiveness of services. Conducts outreach to members 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 members' 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 our external partners and providers. Make referrals to various departments, community-based organizations, and governmental agencies when health and/or psychosocial condition(s) indicate the need for appropriate referrals. 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 the 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 our benefits, programs, and processes, in order to provide clear information to members 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. Requirements and Qualifications: Bachelor's or Associate's degree. Two (2) years of 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 an RN, LCSW, LMFT. PHN preferred. Will consider an unlicensed Master's Level Social Worker (MSW/ASW). Certification as a Certified Case Manager (CCM) preferred 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 with care transitions and discharge planning. HIPAA and other applicable federal and state regulations for confidentiality. Desired Skills and Experience Case Management, Clinical Care Management, Care Coordination, Managed Care, Comprehensive Health Assessments, Psychosocial Assessments, Physical Health Assessments, Functional Assessments, Social Determinants of Health, Individualized Care Planning, Person-Centered Care, Interdisciplinary Care Teams, Case Conferences, Continuum of Care, Long-Term Services and Supports (LTSS), Behavioral Health Services, Community Resource Coordination, Member Outreach, Acuity Monitoring, Care Transitions, Discharge Planning, Referral Management, Patient and Caregiver Education, Medication Education, Medicare, Medi-Cal, MedHOK, Clinical Documentation, Quality Improvement, HIPAA, Patient Confidentiality, Vulnerable Populations, Elderly and Disabled Populations, Registered Nurse (RN), Licensed Clinical Social Worker (LCSW), Licensed Marriage and Family Therapist (LMFT), Public Health Nurse (PHN), Master of Social Work (MSW), Certified Case Manager (CCM), Microsoft Office Bayside Solutions, Inc. is not able to sponsor any candidates at this time. 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