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Care Manger RN - Home Health
Ref No.: 18-00179
Location: Rancho Cucamonga, California
Position Type:Direct Placement
Start Date: 08/24/2018
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.


Under the general supervision of the Manager, Behavioral Health Integration Services and Supports and direct supervision of the Supervisor, Integrated Complex Care, this position is responsible for working effectively with the Health Home Team (HHT) to provide high quality, effective care management to Company members. Care management is broadly defined, and can include outreach and engagement to members, engaging members in skilled therapeutic interactions to promote health behaviors, other behavioral health interventions within scope, coordination of care, resource linkages, working with other professionals and organizations in the community to ensure quality of care for members, seamless transitions of care, and facilitating the right care and the right time for the member. This position works collaboratively with members of the Health Home Team (HHT), members and families, and other professionals, in addition to working collaboratively with the designated health care organization's (HCO) medical team. This position, like all positions within Company, is expected to model whole health principles of relationship-based care, as well engage in promoting education and understanding of physical health and healthy behaviors to those within Company and in the community.

  1. Responsible for primarily working with a caseload of Members with medical needs.
  2. Responsible for utilizing brief medical interventions as necessary to improve the Member's ability to manage their own health.
  3. Provide formal and informal training and support for HHT members on medical conditions, including treatments and evidence-base for treatment.
  4. Represents the HHT as the lead member when necessary.
  5. Responsible for assisting Members with care coordination needs, including, but not limited to, the following:
    1. Conduct comprehensive, holistic assessment according to the scope of the RN license
    2. Assimilate assessment information into an individualized care plan (ICP)
    3. Communicate ICP with Member, approved family or caregiver and other Members of the care team
    4. Lead inter/transdisciplinary care team meetings to share information, update and inform care plan
    5. Coordinate with internal and external health partners to support Members comprehensive care needs
    6. Participate and lead care transition plan responsibilities.
  6. Model the highest ethical behavior in relationships with co-workers, supervisors, Members, Providers, and colleagues in the community.
  7. Responsible for promoting a collaborative and effective working environment within the HHT by engaging in evidenced-based communication strategies (such as Motivational Interviewing) when discussing responsibility/sharing of tasks, effectively resolving conflicts as they arise, and collaborating on Member case discussions.
  8. Responsible for building and maintaining a positive working relationship with Providers, including, but not limited to, communication via in-person, over the phone, and through digital means such as email and fax.
  9. Responsible for engaging with Members, both in-person and on the phone, in a manner that utilizes evidence-based approaches (such as Motivational Interviewing) that promotes collaboration between the Member and his or her medical/behavioral team, as well as to increase the Member's sense of control over their whole health.
  10. Model commitment to continuous quality improvement by engaging in quality improvement initiatives and projects, such as by identifying and addressing HEDIS gaps, and by identifying, developing, and testing new practices for improving the outcomes of the HHT.
  11. Assists with the coordination of medical and behavioral health access issues with PCP offices, specialists, and ancillary services.
  12. Ensures documentation is accurate and in compliance with regulatory requirements and accreditation standards.
  13. Participates in Health Plan staff meetings, trainings, committee meetings, or other activities as needed or as directed by Leadership Team Members.
  14. Ensures the privacy and security of PHI (Protected Health Information) as outlined in Company's policies and procedures relating to HIPAA compliance including attending annual compliance training.
  15. Any other duties as required to ensure Health Plan operations are successful.

  • Possession of a valid RN License for California required
  • Possession of a valid CA Drivers License and proof of Auto Insurance required
  • 3 or more years of care management experience in a Health Care Organization or Managed Care setting preferred
  • Minimum 1 year clinical experience in an acute care facility, skilled nursing facility, home health or clinic setting
  • Full time Direct Hire
  • $85k Annually