Clinical Care Manager - CA

Job Description

Job Description

We are seeking a Clinical Care Manager – CA to join our team at Independent Living Systems (ILS). ILS, along with its affiliated health plans known as Florida Community Care and Florida Complete Care, is committed to promoting a higher quality of life and maximizing independence for all vulnerable populations.

About the Role:

The Clinical Care Manager plays a pivotal role in coordinating and overseeing patient care to ensure optimal health outcomes. This position involves managing care plans, collaborating with multidisciplinary healthcare teams, and serving as a liaison between patients, families, and providers. The Clinical Care Manager is responsible for assessing patient needs, facilitating access to appropriate services, and monitoring progress to adjust care strategies as necessary. By integrating clinical expertise with strong organizational skills, this role aims to enhance patient satisfaction and improve overall care quality. Ultimately, the Clinical Care Manager ensures that care delivery is efficient, patient-centered, and aligned with best practices and regulatory standards.

Minimum Qualifications:

• Bachelor’s degree in Nursing, Social Work, Healthcare Administration, or a related field.
• Requires at least 5 years of experience in clinical care coordination or case management.
• Requires knowledge of and experience working with community agencies and programs.
• Current and valid professional BSW, MSW or LVN, RN, licensure in the State of CA.
• Requires experience with Medi-Cal eligibility guidelines, application, and renewal/redetermination process.
• Requires strong problem-solving and customer service skills.
• Must be a CA Resident and must reside in CA while employed
• Current and valid California (CA) Driver’s License.
• Must use personal vehicle and current vehicle registration required.
• Proof of auto insurance required, must maintain CA minimum insurance coverage.
• CPR Certification required
• Relevant experience may substitute for educational requirement on a year-for-year basis.

Preferred Qualifications:

• Master’s degree in Nursing, Social Work, Public Health, or Healthcare Administration.
• Certification in Case Management (CCM) or equivalent credential.
• Experience working within California’s healthcare system and familiarity with state-specific healthcare policies.
• Demonstrated expertise in managing chronic disease populations and complex care cases.
• Bilingual abilities, particularly in Spanish, to effectively communicate with diverse patient populations.

Responsibilities:

• Develop, implement, and monitor individualized care plans for patients with complex medical needs.
• Coordinate communication among healthcare providers, patients, and families to ensure continuity of care.
• Conduct comprehensive assessments to identify patient needs, risks, and barriers to care.
• Facilitate referrals to appropriate healthcare services and community resources.
• Track patient progress and outcomes, adjusting care plans as necessary to meet evolving needs.
• Ensure compliance with healthcare regulations, policies, and quality standards.
• Provide education and support to patients and families regarding treatment plans and health management.
• Collaborate with insurance providers and case management teams to optimize resource utilization.