Clinical Care Manager

About the Role

The Clinical Care Manager will perform comprehensive assessments, develop individualized care planning, initiate and coordinate interdisciplinary case conferences with providers of service, and support members in creating and adhering to person-centered care plans. Additionally, the role involves coordinating services with other departments, providers, programs, and community partners to provide support.

Responsibilities

• Manage a panel of assigned members to guide them along the continuum of care to the optimal functional level and quality of life.
• Conduct comprehensive assessments and annual or as-needed reassessments of the member's psychosocial, physical health, functional abilities, and social determinants of health.
• Develop an individualized care plan based on assessment information that is member-centered, comprehensive, and consistent with program guidelines, policies, and procedures.
• Identify members' need for LTSS programs, Behavioral Health Services, community supports, and other services to fill gaps in care, and monitor the effectiveness of services.
• Conduct outreach to members for care plan review, needs assessment, and acuity monitoring.
• Establish and maintain open and effective communication with physicians and other health care and social service workers, providing appropriate information while maintaining confidentiality.
• Maintain necessary and complete documentation for all case management activities in the plan's case management system, MedHOK.
• Lead and/or participate in clinical huddles and interdisciplinary care team meetings with internal company staff and external partners and providers.
• Make referrals to various departments, community-based organizations, and governmental agencies when health and/or psychosocial conditions indicate the need.
• Promote clear communication among the care team, including family and community supports, and treating providers regarding member care plans and care transitions.
• Teach appropriate interventions, link to resources, educate about benefits, and discuss medication effects and side effects with the patient, caregiver, and others as appropriate.
• Adhere to case management practice standards at all times.
• Participate in continuous quality improvement efforts.
• Maintain knowledge of benefits, programs, processes, community resources, and confidentiality practices and standards.

Requirements

• Bachelor's or Associate's degree.
• Two (2) years of clinical experience.
• Three (3) years of managed care experience, preferably in Care Coordination.
• Experience working with the health needs of the population served.
• At least one year of direct Care Coordination experience.
• Valid California license as an RN, LCSW, LMFT. PHN preferred. Will consider an unlicensed Master's Level Social Worker (MSW/ASW).
• Certification as a Certified Case Manager (CCM) preferred.
• Proficiency in Microsoft Office Suite applications, including Outlook, Word, Excel, Access, and PowerPoint.
• Knowledge of case management principles and practices.
• Strong knowledge of Medicare and Medi-Cal programs and benefits.
• Advanced knowledge of community resources.
• Understanding of the complexities of working with the elderly, vulnerable, and disabled populations.
• Expanded knowledge of social determinants of health.
• Understanding and familiarity with care transitions and discharge planning.
• Knowledge of HIPAA and other applicable federal and state regulations for confidentiality.

Skills

• Case Management
• Clinical Care Management
• Care Coordination
• Managed Care
• Comprehensive Health Assessments
• Psychosocial Assessments
• Physical Health Assessments
• Functional Assessments
• Social Determinants of Health
• Individualized Care Planning
• Person-Centered Care
• Interdisciplinary Care Teams
• Case Conferences
• Continuum of Care
• Long-Term Services and Supports (LTSS)
• Behavioral Health Services
• Community Resource Coordination
• Member Outreach
• Acuity Monitoring
• Care Transitions
• Discharge Planning
• Referral Management
• Patient and Caregiver Education
• Medication Education
• Clinical Documentation
• Quality Improvement

Pay

$47.04 - $58 per hour

This is a W2 contract role. Candidates must qualify as a W2 candidate. Location: South San Francisco, CA - Remote Role.