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Cal Medi-Connect Case Manager (RN or LVN)
Ref No.: 16-11045
Category: Permanent Placement
Location: Covina, California
 
 
Cal MediConnect Case Manager, RN

Job Summary:
 
  • Responsible for the assessment, planning, intervention, monitoring, and evaluation of all Cal-Mediconnect patients.
  • Assess and develop a care plan in collaboration with the multidisciplinary care team and the member and family if appropriate.
  • Effectively coordinate members care in the community setting to assure optimum health outcomes and prevent unnecessary acute care admissions and emergency room visits.
  • Deliver case management services that are patient centered and assist the member to achieve optimum health outcomes throughout the care continuum.
  • Establishes and maintains a relationship with Member where CM is continuing point of contact for the Member for all health and psychosocial needs
  • Keeps member/family members or other customers informed and requests if necessary, further assistance when needed.
  • Communicates the Duals Care Coordination process to Member/family/physicians and other Care Coordination team members explaining Member’s right to refuse care coordination and accept as desired and the benefits of the program to the Member/family/physicians at no cost to the Member.
  • Demonstrates the ability to follow through with requests, sharing of critical information, and getting back to individuals in a timely manner.
  • Functions as care coordinator between Member, primary care provider, and multidisciplinary care team. Is the convener of the ICT.
  • Interacts professionally with Member/family/physicians and all other participants in the ICT and involves them in formation of the plan of care.
  • Performs a Clinical and Social Assessment (CSA) of the Member and determines an acuity score for necessary scheduled follow-up. Utilizes HRA results, reports from home visits, LCSW, BH, LTSS assessments to create a complete view of Member needs.
  • .
  • Manages transition of care from the sending to receiving settings ensuring that the Plan of Care moves with the member and updates/modifies the care plan as the member’s health care status changes.
  • Communicates appropriately and clearly with physicians, In-Patient case managers and Prior-Authorization nurses
  • Identifies and addresses psychosocial needs of the members and family and facilitates consultations with Social Worker, as necessary.
  • Establishes contact with other health plans and cooperate in exchange of information for Members gained or lost.
 
Qualifications:
 
  • Valid State Licensed/LVN or RN
  • Previous experience in a medical management or managed care setting
  • Acute experience working in ER, Urgent Care, or Telemetry a huge plus
  • Proficiency in operating computers applications, excellent interpersonal skills, verbal and written communications skills.

Compensation:

Comprehensive Benefits and Competitive Salary