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Care Manager
Ref No.: 18-00125
Location: Rancho Cucamonga, California
Position Type:Full Time/Contract
Start Date / End Date: 05/27/2016 to 12/03/2018
CLIENT COMPANY OVERVIEW
Our Client is a not-for-profit, rapidly growing Medi-Cal and Medicare health plan serving over 1,138,447 residents of the Riverside and San Bernardino counties. Our client maintains a Positive Team Culture as demonstrated by being voted by Los Angeles News Group readers as "Favorite Overall Company to Work For , "Favorite Training Program , and "Favorite Workplace Culture in their 2014 Winning Workplaces survey.

JOB TITLE
CARE MANAGER - RN

DESCRIPTION
Under the general direction of the Care Management Manager, the Care Manager is responsible for working directly with the Plan, IPA medical groups, providers, hospitals, community agencies, Members/caregivers, and other entities supporting Member care to ensure coordinated, continuous care and serve as a resource person to these facilities. The RN Care Manager supports the care team, finalizes the care management assessment and Individualized Care Plan (ICP).
  • Responsible for serving as a resource for Members and Providers for care management and continuity of care.
  • Responsible for assessing Members for appropriate care management needs:
  1. Conduct clinical assessment and medication reconciliation.
  2. Develop, implement, and evaluate individualized care plans (ICP)
  3. Review and revise contributions to assessment information and care planning from care team members (i.e. LVN Care Manager, Care Coordinator) as appropriate
  4. Act as a Member advocate
  5. Serve as a liaison between Member, caregivers, and providers
  6. Educate and support Members/caregivers with meeting ICP goals
  7. Identify need for Interdisciplinary Care Team (ICT), organize the participants to be included and ensure facilitation and documentation of the ICT.
  • Review and revise contributions to assessment information and care planning from care team members (i.e. LVN Care Manager, Care Coordinator) as appropriate.
  • Assist with referrals for  Members that are eligible for carve out programs such as CCS, multi-organ transplant, etc
  • Assist members with immediate needs with regard to access, referrals and authorizations.
  • Assist member with resources such as LTSS, Independent Living and Diversity Services, Behavioral Health, and Community Resources
  • Responsible for any other duties as required ensuring successful care management processes and Member outcomes using critical thinking and innovative techniques to engage and retain Members in the CM program.       
  • Any other duties as required or assigned to ensure Health Plan operations are successful.
  • Ensure the privacy and security of PHI (Protected Health Information) as outlined in 's policies and procedures relating to HIPAA compliance.
SKILLS & QUALIFICATIONS
  • Valid RN licensed issued by the State of California
  • Three (3) or more years of care management experience in a health care delivery setting. 
  • Experience in an HMO or experience in Managed Care setting preferred. 
  • Minimum 1 year clinical experience in an acute care facility, skilled nursing facility, home health or clinic setting preferred.
COMPENSATION | POSITION CLASSIFICATION
  • Commensurate with Experience
  • Full Time | Contract Assignment

JOB TITLE
CARE MANAGER – LVN

DESCRIPTION
Under the general direction of the Care Management Manager, the LVN Care Manager is responsible for working directly with the Plan, IPA medical groups, providers, hospitals, community agencies, Members/caregivers, and other entities supporting Member care to ensure coordinated, continuous care and serve as a resource person to these facilities.  The LVN Care Manager works closely with the RN Care Manager and other members in the care team to support the member in the care management process. Responsible for serving as a resource for Members and Providers for care management and continuity of care.
  • Responsible for serving as a resource for Members and Providers for care management and care coordination.
  • Responsible for screening  Members for appropriate care management needs, documenting findings and communicating the findings to the RN Care Manager.
  • LVN Care Manager uses approved screening tools which contribute to the assessment (i.e. Health Risk Assessment or other designed tool)
  • Contributing to the development and modification of the Individualized Care Plan (ICP) including: 
  • Reviewing ICP recommendations with RN Care Manager Team Member and other Interdisciplinary Care Team (ICT) members as appropriate
  • Educating Members according to approved plan and material content
  • Communicating unexpected results with RN Care Manager Team Member and other ICT members as appropriate.
  • Acts as a Member advocate at all times
  • Serves as a liaison between Members, caregivers and all members of the ICT
  • Assist and facilitate referrals for Members that are eligible for carve-out programs such as CCS, multi-organ transplant, etc.
  • Assist members with immediate needs with regard to access, referrals and authorizations.
  • Facilitates referrals to resources such as LTSS, Independent Living and Diversity Services , Behavioral Health, and community resources.
  • Responsible for any other duties as required to ensure successful care management processes and Member outcomes.       
  • Under the direction of designated supervisor or request from a licensed Team Member (i.e. RN Care Manager), other duties as required to ensure Health Plan operations are successful.
  • Ensure the privacy and security of PHI (Protected Health Information) as outlined in policies and procedures relating to HIPAA compliance.
SKILLS & QUALIFICATIONS
  • Possession of a valid LVN license issued by the State of California.  Possession of a valid State of California driver's license.
  • Three (3) or more years of care management experience in a health care delivery setting. 
  • Experience in an HMO or experience in Managed Care setting preferred. 
  • Minimum 1 year clinical experience in an acute care facility, skilled nursing facility, home health or clinic setting preferred.
COMPENSATION | POSITION CLASSIFICATION
  • Commensurate with Experience
  • Full Time | Contract Assignment