Case Manager Clinicas del Camino Real, Inc.

• 3.3 Camarillo, CA Job Details Full-time $85,000
• $95,000 a year 19 hours ago Benefits Health insurance Dental insurance 401(k) Paid time off Vision insurance Employee discount Life insurance Retirement plan Qualifications LVN RN License Driver's License Case management Health information management Full Job Description

JOB OBJECTIVE

The Case Manger (CM) will work in office, and/or field settings supporting our Clinicas del Camino Real membership. Performs care management duties to assess, plan and coordinate aspects of medical and supporting services across the continuum of care for member identified to be medium rising risk or high utilizers. This position works with the care management and coordination teams to identify care medical and social needs and to establish support services to promote quality member outcomes.

ESSENTIAL FUNCTIONS AND RESPONSIBILITIES

The case manager plays a primary role in working with medium rising risk members or high utilizers to improve their health outcomes through medical and social care coordination approaches, community engagement, and targeted programs to support the unique needs of each assigned case management member. Case management strategies will be driven by incorporating the member's ethnicity, age, specific chronic health conditions, social designations such as SUDs, prisoners, survivors of abuse, and those with mental health issues. The fundamental principles of case management include: 1. Assessment

• involves a comprehensive collection of data and ongoing collaborative process of observation, information gathering, reflection and engagement with the client, and analysis of the client's overall situation and needs. 2. Member Centric
• actively participate in and are at the center of decision making and support planning. This fosters trust and ensures that the services provided align with the Members' expectations and needs by Empowering them to take an active role. 3. Planning to establish specific objectives and care goals, both short
• and long-term, based on the client's needs identified earlier in the assessment process.

4. Effective Communication Individual CM extends to writing concise and accurate reports, documentation, and referrals and leveraging technology to facilitate collaboration. Members utilize effective listening to understand the Member's needs, concerns, and feedback, ensuring that they feel heard and respected. promote seamless communication among all team members supported by regular meetings and shared data methodologies. 5. Conduct Regular Evaluations

• Regularly evaluate the case management processes to identify strengths and pinpoint areas for improvement.

Such as encourage regular client check-ins and perform ongoing updates and activities resulting from CM arrangements such as PCP, Specialty and Community encounters. 6. Advocacy Skills . As the case manager, to advocate on behalf of assigned CM members to ensure they receive the services and support to promote quality CM outcomes.

ESSENTIAL FUNCTIONS AND RESPONSIBILITIES

(Continued) The Case Manager works within a team environment to:

• Develop, guide and provide case management services by utilizing clinical expertise, and coordination efforts with the medical management team, community supports and contracted upstream health plan.
• Analyze medical trends and intervene with members identified to be at rising medium risk and/or high utilizers.
• Interact with members' primary care physicians, and specialists to provide seamless case management activities across the care continuum,
• Interact with community/system resources, and maintain resource directories of collaborative and supporting agencies,
• Establish individualized member care plans that incorporate prioritized case goals, implementation plans, and ongoing measurement of outcomes,
• Access and utilize data from various data systems to create a comprehensive member case file that is supported with member assessments, clinical reports, encounters, community appointments, medication management, and identified SDOHs.
• Collaborate with healthcare professionals to assess, plan, and coordinate patient care needs.
• Participate in quality improvement activities to enhance clinical outcomes and resource utilization.
• Collect and analyze patient information for third-party vendors,
• Arrange or participate in member case conferences internally at CDCR, externally with GCHP and community agencies.
• Submit timely progress reports and updated member care plans and profiles as necessary to support continuum in the member's case management process.
• Performs telephonic assessment to assess member needs and collaborate with resources and provides education/support for treatment regimen adherence and medication management to support self-management and independent living.
• Identifies potential care gaps and makes referrals as appropriate.
• Identifies available community services and health resources and facilitates access to care and services available to patient/family when needed.

Collects, documents, and maintains all member information and care management activities to ensure compliance with current state, federal, and third-party payer regulations Makes referrals for Complex Case Management, Enhanced Case Management, or Basic Case Management. Provides feedback to leadership on opportunities to improve and enhance care and quality delivery for members in a cost-effective manner

• Attends all required team/staff meetings.
• Performs other duties as assigned by people leader to meet business needs

EXPERIENCE AND EDUCATION REQUIREMENTS

• Any of the following: Completion of an accredited Registered Nurse (RN) program or accredited Licensed Vocational Nurse (LVN) or Licensed Practical Nurse (LPN) Program.
• 1-3 years in case management, disease management, managed care or medical or behavioral health settings.
• Valid RN or LVN/LPN license is required for the job. License must be active, unrestricted and in good standing.
• A valid driver's license with good driving record and be able to drive within applicable state or locality with reliable transportation.

PREFERRED EXPERIENCE

• 3-5 years in case management, disease management, managed care or medical or behavioral health settings.
• Spanish speaking preferred.

PREFERRED LICENSE, CERTIFICATION, ASSOCIATION

• Certified Case Manager (CCM) or Certified in Health Education and Promotion (CHEP)

Pay:

$85,000.00

• $95,000.

00 per year

Benefits:

401(k) Dental insurance Employee discount Health insurance Life insurance Paid time off Retirement plan Vision insurance

Work Location:

In person