Case Manager-RN-CPSP - Lamont CHC

Job Description

Job Description

Clinica Sierra Vista is excited to be one of the largest Federally Qualified Health Centers in the Nation! We’re honored to serve the men and women of the fields. We also offer care and support to the inner city, the rural and isolated, those of low, moderate, and fixed incomes, and families from an array of cultural backgrounds who speak several languages. We don’t inquire about immigration status because we simply don’t need to know. If you come to us, we will treat you like any other patient.

As we grow our team, we are looking for individuals who believe the patient is always #1.

Why work for us?

• Competitive pay which matches your abilities and experience
• Health coverage for you and your family
• Generous number of vacation days per year
• A robust wellness plan and health club discounts
• Continuing education assistance to grow and further your talents
• 403(B) plan with company matching

Intrigued? We’d love to hear from you! Please review the job details below and then click “apply.”

We're looking for someone to join our team as a Case Manager RN CPSP who:

The Registered Nurse (RN) – Case Manager collaborates closely with Community Patient Health Workers (CPHWs) and healthcare providers to ensure high-quality patient care. This role is responsible for reviewing CPHW documentation, monitoring lab results for abnormalities, coordinating provider orders within the Electronic Health Record (EHR) system, and providing health education to pregnant patients enrolled in Comprehensive Perinatal Services Program (CPSP) services. The RN plays a key role in coordinating care and improving maternal and fetal health outcomes.

Essential Functions:

• Case coordination of Obstetric patients enrolled in CPSP services as directed by the Women’s Health Director, California Department of Public Health and CPSP protocols.
• Educate patients enrolled in CPSP with up- to- date information, providing higher quality of care.
• Facilitate implementation of changes in evidence-based care as it relates to Maternal Health.
• Review prenatal records for high-risk factors and follow direction of Obstetric Provider to determine level of care appropriate for the patient.
• Assess patient Obstetric, Medical and Family history for any concerns that increase risk to pregnancy and forward to Obstetric Provider for review.
• Provide patient education regarding access to prenatal care from outside agency if patient’s pregnancy deemed high- risk requiring a higher level of care.
• Ensure the Individualized care plan is complete and appropriate for patient needs, assess effectiveness of interventions and modify care plan as needed.
• Ensure patient receives integrated care that addresses patient needs and promotes patient involvement.
• Assess psychosocial, nutrition and health education need of the patient and ensure appropriate community resources and referrals provided, including but not limited to, housing, transportation, behavioral health, dental, genetic screening, and intimate partner violence.
• Assess patient weight gain in pregnancy and refer to nutrition services as needed
• Provide patient education on risk factors for the pregnancy and prevention of complications.
• Assess patient understanding. taking into consideration language barrier, education level, presence of any disabilities, cultural and gender diversity.
• Collaborate with Obstetric Provider regarding patient care plan.
• Function as the liaison between the patient and the health care team to promote effective communication.
• Educate patients on the purpose for testing, labs and interventions.
• Educate patients on risk factors in which Perinatology consultation is ordered by OB Provider and assess patient’s understanding of importance in attending.
• Track patient attendance at appointments and assess barriers to prenatal care utilization.
• Participate in case conferencing on the 4th Tuesday of the month and Residency OB team lead meeting monthly and weekly with preferred Perinatologist.
• Provide assistance to Residency OB team and attend Didactics as needed for presentations
• Other duties as required. See attachment for full job description.

You'll be successful with the following qualifications:

• AA/AS in a health, social science or related field required and/or graduation from an accredited School or License in Registered Nursing. Must have a license from the California Board of Nursing preferred.
• Minimum one-year relevant work experience in related field and/or minimum two years nursing experience (ambulatory/obstetrical nursing preferred).
• Knowledge of community resources desirable.
• Knowledge of socio-economic environmental and cultural factors affecting patient’s health care.
• Ability to work effectively in an interdisciplinary team approach with both professionals and paraprofessionals.
• Ability to communicate effectively both orally and in writing with persons from diverse social, economic and cultural backgrounds.
• Ability to maintain patient dignity and confidentiality.
• Bilingual and biliterate in Spanish desirable.
• Willingness to work non-regular hours as required.
• Minimum of one-year supervisory experience.
• Committed to the belief in health care with dignity for all, and that people have the right to health care information and participation in planning their own health care.
• Must adhere to Clinica Sierra Vista’s employee health/immunization requirements or provide a valid exemption request for subsequent approval.

Clinica Sierra Vista values human rights, goodwill, respect, inclusivity, equality, and recognizes that the organization derives its strength from a rich diversity of thoughts, ideas, and contributions. As leaders in healthcare industry, we aspire to be an employer of choice by promoting an organizational culture that reflects these core values. We seek to attract, develop, and retain a talented and dedicated workforce where people of diverse races, genders, religions, cultures, political affiliations and lifestyles thrive. Our goal is to create a welcoming and inclusive environment that empowers our employees to provide the highest level of service to our community of residents and businesses; they’re counting on us.

Clinica Sierra Vista is an equal opportunity employer and strives to attract qualified applicants from all walks of life without regard to race, color, ethnicity, religion, national origin, age, sex, sexual orientation, gender identity, gender expression, marital status, ancestry, physical disability, mental disability, medical condition, genetic information, military and veteran status, or any other status protected under federal, state and/or local law. We aim to create an environment that celebrates and embraces the diversity of our workforce. We welcome you to join our team!