Care Manager (OneCare)

We are a mission-driven community-based organization that serves member health with excellence and dignity, respecting the value and needs of each person. If you are ready to advance your career while making a difference, we encourage you to join us in building healthier communities for all.

About the role

As a Care Manager (OneCare), you will be an integral part of our Case Management team, helping to strive for excellence while serving our members' health with dignity. This position has been approved to be a Community Worker. If telework is approved, you are required to work within the State of California only, and if Partial Telework, you must come into the Main Office in Orange, CA, at least two days per week minimum.

Case Management is an advanced specialty collaborative practice responsible for providing case management services for CalOptima Health OneCare members. The Care Manager will facilitate communication and coordination among all participants of the healthcare team and the OneCare member to ensure services promote quality and cost-effective outcomes. You will provide intensive case management, including assessment, care planning, implementation, coordination, monitoring, and evaluation of the member's needs. You will meet with members in-person in the setting of their choosing, aligning with member preference.

Responsibilities

• Care Management (85%)
  • Assess member needs using a standardized health needs assessment or health risk assessment.
  • Perform comprehensive, disease-specific, clinical assessments of all identified cases, at minimum, annually, including:
    • Member's physical, functional, social, and psychological status.
    • Member's cultural and linguistic needs.
    • Caregiver resources and available benefits.
  • Perform post-discharge assessment to identify member's post-hospital or post-ED discharge needs, including:
    • Member's physical, functional, social, and psychological status.
    • Member's cultural and linguistic needs.
    • Caregiver resources and available benefits.
    • Follow-up provider care and ensuring scheduled appointments.
    • Durable medical equipment and supplies.
    • Community resources.
  • Develop and implement a member-specific care plan with prioritized SMART goals. Continuously review, modify, and update the care plan to reflect the member's needs, at minimum, annually or upon change in condition.
  • Schedule follow-ups to assess progress toward goals and identify barriers to meeting goals.
  • Provide regular outreach to assigned members and evaluate the quality of service according to department contact standards.
  • Coordinate care and services with members, their family members/representatives, and other providers, including Community Supports and LTSS.
  • Conduct face-to-face meetings in various settings (e.g., hospitals, skilled nursing facilities, long-term acute care hospitals, recuperative care, and members' homes).
  • Communicate with members' physicians, specialists, community agencies, and vendors to ensure coordination of services.
  • Facilitate referrals to behavioral health/substance use disorder services and identify and make referrals to Long-Term Support Services (LTSS) department, Community Supports, and community resources.
  • Facilitate and participate in Interdisciplinary Care Team meetings, as applicable.
  • Collaborate with interdepartmental staff in case resolution as needed.
  • Identify cases needing manager, director, or medical director review or input, route accordingly, and close cases according to procedures and guidelines in a timely manner.
  • Prepare and maintain appropriate documentation of patient care and progress within the documentation platform or care plan.
  • Advocate for the member's best interest regarding necessary funding, treatment alternatives, timelines, coordination of care, and frequent evaluations of progress and goals.
• Administrative Support (10%)
  • Participate in a mission-driven culture of high-quality performance with a focus on customer service, consistency, dignity, and accountability.
  • Assist the team in carrying out department responsibilities and collaborate with others to support short- and long-term goals/priorities.
  • Follow CalOptima Health's protocol for documenting all case interventions.
  • Ensure reporting of productivity metrics to supervisor.
• Other (5%)
  • Complete other projects and duties as assigned.

Requirements

• Master's degree in social work, psychology, gerontology, public health, social science, or related field plus 3 years of clinical experience and/or managed care experience.
• Valid driver's license and vehicle or other approved means of transportation, an acceptable driving record, and current auto insurance (required for work away from the primary office 51% of the time or more).

Qualifications

The following qualifications will help you stand out:

• Licensed Vocational Nurse, Licensed Marriage and Family Therapist, or Licensed Clinical Social Worker.
• Experience with behavioral health or substance use case management.
• Certified Case Manager (CCM) certificate.
• Bilingual in English and one of CalOptima Health's defined threshold languages (Arabic, Farsi, Chinese, Korean, Russian, Spanish, Vietnamese).

Skills

• Develop rapport and establish effective working relationships with leadership, staff, and external contacts at all levels and with diverse backgrounds.
• Work independently and exercise sound judgment.
• Communicate clearly and concisely, both orally and in writing.
• Work a flexible schedule, including availability for evening and weekend events.
• Organize, analyze, problem-solve, and manage projects effectively.
• Work in a fast-paced environment efficiently and manage multiple projects.
• Identify opportunities for internal and external collaboration.
• Motivate and lead multi-program teams and external committees/coalitions.
• Utilize computer and appropriate software (e.g., Microsoft Office: Word, Outlook, Excel, PowerPoint) and job-specific applications/systems.

Physical Requirements

• Ability to visually read information from computer screens, forms, and other printed materials.
• Ability to speak clearly in conversation and general communication.
• Hearing ability for verbal communication/conversation/responses via telephone and face-to-face interactions.
• Manual dexterity for typing, writing, standing, reaching, flexibility, body movement for bending, crouching, walking, kneeling, and prolonged sitting.
• Lifting and moving objects, patients, and/or equipment weighing 10 to 25 pounds.

Benefits

• Competitive compensation: Pay Grade 310 - $72,096 - $115,353 ($34.66 - $55.4582 per hour). The final salary offered will be based on education, job-related knowledge, experience, skills, and internal equity.
• This position is approved for Community Worker (if telework, eligible in California only).
• A comprehensive benefits package and CalPERS pension program with additional retirement packages.
• Generous PTO program and a focus on work-life balance.
• Various wellness programs, tuition reimbursement, and professional development opportunities.
• Career development opportunities and flexible scheduling.

Work Environment

• If located at the 500, 505 Building or a remote work location:
  • Work is typically indoors and sedentary, subject to schedule changes and/or variable work hours, with travel as needed.
  • No harmful environmental conditions; noise level is usually moderate.
• If located at PACE:
  • Work is typically indoors in a clinical setting serving the frail and elderly.
  • May involve harmful or hazardous environmental conditions; noise level is usually moderate to loud.
• If located in the community:
  • Work is typically indoors and sedentary, subject to schedule changes and/or variable work hours, with travel as needed.
  • Occasional outdoor work in varied temperatures; may involve harmful or hazardous environmental conditions.
  • Noise level is usually moderate to loud.