Case Management Specialist RN (Bilingual)

About the role

The Case Management Specialist RN (Bilingual) works collaboratively with an assigned panel of physicians to manage the patients' specialized needs. The managing team differs according to the chronic disease. Duties include assessing to identify member needs and developing a specific care management plan to address those needs. In conjunction with the physician, the plan is implemented by coordinating access to health services across multiple providers and disciplines, monitoring care, arranging transportation and transfers if necessary, identifying cost-effective measures, recommending alternative levels of care and utilizing resources, promoting self-care management, ensuring paperwork is completed, and participating in data collection and analysis.

Responsibilities

• Evaluates and identifies member needs.
• Interfaces with primary care physicians, specialists, and various disciplines on the development of case management plans/programs.
• Maintains and evaluates the effectiveness of case management plans and modifies as necessary.
• Collaborates with multidisciplinary teams to provide continuity of care, including utilization management, transfer coordination, discharge planning, and obtaining all authorizations/approvals/transfers as needed for outside services for patients/families.
• Serves as a clinical liaison, per their specialty, with outside agencies such as County CCS, non-plan facilities, outside providers, employers, and/or workers compensation carriers and third-party administrators.
• Prepares reports, communicates program changes to appropriate staff, and develops protocols in accordance with state regulations.
• Acts as a patient advocate and educator to ensure the patient has the knowledge to manage their condition and is educated and empowered to participate in the plan of care.
• Develops individualized patient/family education plans focused on self-management, delivers patient/family education specific to a disease state, prepares training and educational materials, and presents to appropriate staff, members, and families.
• Facilitates patients' return to normal daily activities by teaching and making appropriate referrals for outside services/continued care.
• Consults with internal and external physicians, health care providers, discharge planners, and outside agencies regarding continued care/treatment or hospitalization or referral to support services or placement.
• May need to facilitate transportation and housing arrangements for the patient.
• Coordinates the transmission of clinical and benefit treatment to patients, families, and outside agencies.
• Participates in data collection and analysis of clinical outcomes of care and customer satisfaction standards.
• Participates in the formulation and implementation/monitoring of action strategies and outcomes of care or customer service.
• Ensures accurate records are maintained of the care associated with each patient.
• Interprets regulations, health plan benefits, policies, and procedures for members, physicians, medical office staff, and contract providers and outside agencies.

Requirements

• Minimum two (2) years clinical experience as an RN in an acute care or ambulatory care setting required.
• Bachelor's degree or equivalent four (4) years of experience required.
• Registered Nurse License (California).
• Basic Life Support.
• Demonstrated ability to utilize/apply the general and specialized principles, practices, techniques, and methods of utilization review/management, care coordination, transfer coordination, discharge planning, or case management.
• Working knowledge of regulatory requirements and accreditation standards (TJC, Medicare, Medi-Cal, etc.).
• Demonstrated ability to utilize written and verbal communication, interpersonal, critical thinking, and problem-solving skills required.
• Computer literacy skills required.
• Bilingual (English/Spanish) Level II required.
• Case Management Certification or certification in the area of specialty preferred.
• Bachelor's degree in nursing or healthcare related field preferred.

Qualifications

• Days and hours may vary, will be cross-trained to work in multiple areas.
• Must successfully pass or have passed the bilingual test (within the last 12 months), or be active in the QBS program.

Benefits

We offer several benefits to our nurses, including:

• Opportunities for lifelong learning to expand knowledge and better serve our patients.
• A culture of compassion, integrity, trust, and open communication.
• Opportunities for growth and development.
• Flexible schedules to accommodate personal commitments.

Pay

Details on pay are not specified in this posting.

Schedule

The Case Management Specialist RN (Bilingual) works on a Per Diem schedule.