Care Manager I - RN

Description

What You'll Do

• Develops and initiates the Individual Care Plan, which is client-centered, com prehensive and consistent with p rog ram guidelines and policies and procedures
• Identifies, arranges for, and monitors appropriate community services based on a good knowledge of Medicare, Medicaid, and other entitlement programs
• Coordinate and facilitate patient care through assessment, evaluation, planning, and implementation
• Communicate patient needs to a variety of care team members and follow up accordingly
• Manage discharge plans upon completion of treatment 
• Work collaboratively with patients, families, physicians, and nurses to ensure high quality care
• Act as the patient's advocate as it relates to insurance coverage and financial assistance
• Maintain the patient's comprehensive clinical record through detailed documentation
• Coordinate an interdisciplinary approach to support timely access to appropriate care, facilitate continuity of care among providers and improve utilization of appropriate resources
• Apply established principles of care transition and follow member through continuum of care as well as coordinate a warm hand-off to the appropriate provider and/or health plan for necessary involvement of continuation of care and services
• Assists UM Manager and participates in all internal and external audits
• Primary liaison with all contracted health plans for case management activities
• Ensure the privacy and security of PHI (Protected Health Information) as outlined in Medical Group/ MSO policies and procedures related to HIPAA compliance
• Other duties and special projects as assigned

Qualifications

• Registered Nurse, Licensed Vocational Nurse, or Medical Assistant required
• Bachelor’s degree in nursing and or a related health services field is preferred
• At least two (2) years’ experience in utilization management including experience applying evidenced based clinical criteria and benefit plans is required
• At least three (3) years’ of clinical experience preferably in case management or related experience is required

• Have a certification as Certified Case Management (CCM)
• Are fluent in Tagalog or Ilocano

Environmental Job Requirements and Working Conditions

• This is a remote position. The home office is located at 1600 Corporate Center Dr., Monterey Park, CA 91754.
• The total compensation target pay range for this role is: $78,000 - $91,000. Actual compensation will be determined based on geographic location (current or future), experience, and other job-related factors.