Medical Case Manager (RN)

Kinetic Personnel Group is currently recruiting a Medical Case Manager (RN) for a $3 billion-dollar a year government public health plan (government agency) is renowned for its work in the community and being a great place to work.

This position is a 6 month temporary position (in-office, onsite) that pays between $45/hr - $65/hr depending on experience. This will become a permanent position for the right candidate.

A full time permanent position includes a pay raise, telecommute options, a CalPERS Pension and excellent government benefits including generous holiday, PTO and sick pay days off, year one!

Position Responsibilities

Care Management

• Assesses member needs using a standardized health needs assessment or health risk assessment.

• Performs comprehensive, disease specific, clinical assessments of all identified cases, which includes but is not limited to, assessment of: 

  • Member’s physical, functional, social and psychological status

  • Member’s cultural and linguistic needs

  • Caregiver resources and available benefits

• Performs post-discharge assessments to identify member’s post-hospital or post-emergency department discharge needs including but not limited to:

  • Member’s physical, functional, social and psychological status

  • Member’s cultural and linguistic needs

  • Caregiver resources and available benefits

  • Follow-up provider care and ensuring scheduled appointments

  • Durable medical equipment and supplies 

  • Community resources

• Develops and implements a member’s specific care plan which includes prioritized Specific, Measurable, Achievable, Relevant, and Time-Bound (SMART) goals.

• Reviews, modifies and updates care plans continuously to reflect the member’s needs, at minimum, annually or upon change in condition.

• Schedules follow-ups to assess progress towards goals and identifies barriers to meeting goals.

• Provides regular outreach to assigned members along with members from a worklist and evaluates quality of service given to members according to department contact standards.

• Coordinates care and services with members, members’ family members/representatives and other providers, as appropriate, including community supports and Long-Term Services and Supports (LTSS).

• Communicates with member’s physicians, specialists, community agencies and vendors to ensure coordination of services.

• Facilitates referrals to behavioral health/substance use disorder services and identifies and makes referrals to LTSS department, community supports and community resources.

• Facilitates and participates in Interdisciplinary Team meetings as applicable.

• Collaborates with interdepartmental staff in case resolution as needed.

• Identifies cases needing supervisor, manager, director or medical director review or input, routes accordingly and closes cases according to procedures and guidelines in a timely manner.

• Advocates in the member’s best interest for necessary funding, treatment alternatives, timelines and coordination of care and frequent evaluations of progress and goals.

Requirements:

• Associates degree in Nursing (ADN); or equivalent work experience required. Bachelor’s degree in Nursing (BSN) preferred.

• Current, unrestricted Registered Nurse (RN) license to practice in the State of California required.

  • 3 years of clinical experience with the health needs of the population served required.

  • An equivalent combination of education and experience sufficient to successfully perform the essential duties of the position such as those listed above is also qualifying.

• Utilization management reviewer experience

• An active Commission for Case Manager (CCM) certification preferred.

• Understand confidentiality and the legal and ethical issues pertaining to case management.

• Bilingual Spanish, preferred

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