Current and Active RN license
Summary :
Responsible for health care management and coordination of Healthcare members in order to achieve optimal clinical, financial and quality of life outcomes.
Works with members to create and implement an integrated collaborative plan of care.
Coordinates and monitors members progress and services to ensure consistent cost effective care that complies with and all state and federal regulations and guidelines.
Essential Functions :
Provides case management services to members with chronic or complex conditions including :
Proactively identifies members that may qualify for potential case management services.
Conducts assessment of member needs by collecting in-depth information information system, the member, members family / caregiver, hospital staff, physicians and other providers.
Identifies, assesses and manages members per established criteria.
Evaluates effectiveness of the care plan and modifies as appropriate to reach optimal outcomes.
Measures the effectiveness of interventions to determine case management outcomes.
Promotes integration of services for members including behavioral health and long term care to enhance the continuity of care for members.
Conducts face to face or home visits as required.
Maintains department productivity and quality measures.
Manages and completes assigned work plan objectives and projects in a timely manner.
Demonstrates dependability and reliability.
Maintains effective team member relations.
Adheres to all documentation guidelines.
Attends regular staff meetings.
Participates in Interdisciplinary Care Team (ICT) meetings. Familiarity with NCQA standards, state / federal regulations and measurement techniques.
Able to maintain regular attendance based upon agreed schedule.
Maintain confidentiality and comply with Health Insurance Portability and Accountability Act (HIPAA).
Skilled at establishing and maintaining positive and effective work relationships with coworkers, clients, members, providers and customers.
Required Education : Bachelor's degree in Nursing or Masters degree in Social Work, or Health Education (a combination of experience and education will be considered in lieu of degree).
Required Experience : 5-7 years of clinical experience with case management experience.
Required Licensure / Certification : Active, unrestricted State Registered Nursing license or Licensed Clinical Social Worker LCSW or Advanced Practice Social Worker APSW in good standing.
A combination of experience and education will be considered in lieu of LCSW or APSW. Must have a valid driver's license with a good driving record and be able to drive locally.
Senior Account Manager Remote Customer Care
A company is looking for a Senior Account Manager. ...
Manager, Customer Care
The Customer Care Manager will serve as our in-house expert on everything Customer Experience and Hydrafacial procedures. They will work closely with our sales regions working directly with the Area Vice Presidents, Regional Sales Directors and Business Development Managers to improve the customer's...
Case Manager (RN) Care Transitions: California
Schedule: Monday thru Friday 8:30AM to 5:30PM PACIFICJOB DESCRIPTIONJob SummaryMolina Healthcare Services (HCS) works with members, providers and multidisciplinary team members to assess, facilitate, plan and coordinate an integrated delivery of care across the continuum, including behavioral health...
Assistant Manager Ambulatory Care RN, Primary Care (East Los Angeles) Bilingual - Spanish
Assists in managing a single department or multiple small departments providing ambulatory patient care services by supervising daily operations and patient care activities. Recommends, implements and evaluates processes to improve systems and patient care results across the continuum of care. Ensur...
Case Manager Continuing Care (Bilingual) PT 28 hrs, Bellflower
In conjunction with physicians, develops treatment plan, monitors care, makes recommendations for alternative levels of care, identifies cost-effective protocols and care paths and develops guidelines for care that may require coordination across systems of multiple providers/services. In conjunctio...
Case Manager Utilization RN-Per Diem - Palliative Care
Collaborates with physicians, other members of the multidisciplinary health care team and patient/family in the development, implementation and documentation of appropriate, individualized plans of care to ensure continuity, quality and appropriate resource use. Makes recommendations to the physicia...
Staff Services Manager Ii (supervisory)
The Department of Health Care Services (DHCS) is the backbone of California’s health care safety net. Our success is made possible by the hard work of more than 4,800 DHCS team members and through collaboration with the federal government and other state agencies, counties, and partners for the care...
Personal Care Sales Account Manager
Our Beauty & Personal Care and Food business units aim to be the customer’s partner of choice in delivering solutions, formulations and ingredients that best meet their needs. ...
RN Care Manager Emergency Room FT Days
Reporting to the Clinical Unit Supervisor the Clinical Staff Nurse has 12-hour accountability for organizing, planning, directing, coordinating, and providing high quality, individualized patient/family centered care based on the Watson Model of Care for a defined group of patients, including the id...
Assistant Manager Ambulatory Care Department
Assists an Ambulatory Care Department Manager by supervising assigned operations of a department providing ambulatory patient care services; ensuring that staff provide high quality, accessible, cost effective care and patient-focused services to members across the continuum which comply with local...