Medical Case Manager

About the role

We are seeking an experienced Medical Case Manager, MSSP to support older adults with complex medical, behavioral, and social needs. This role is responsible for conducting comprehensive assessments, developing individualized care plans, coordinating services, advocating for members, and collaborating with an Interdisciplinary Team (IDT) to promote quality of care and independent community living. The ideal candidate will have a strong background in nursing, case management, public health, home health, hospice, or skilled nursing, along with excellent communication, assessment, care coordination, and problem-solving skills.

Responsibilities

• Conduct in-field, virtual, and telephonic assessments of members' physical, psychosocial, medical, and environmental needs.
• Build trusting relationships with members and families from diverse backgrounds.
• Review medical records, clinical documentation, rehabilitation information, and other relevant case information.
• Determine and document appropriate clinical levels of care in accordance with applicable California regulations.
• Develop, implement, monitor, and update individualized care plans in collaboration with members, families, and the Interdisciplinary Team (IDT).
• Coordinate care with physicians, family members, healthcare professionals, community agencies, and other service providers.
• Identify complex medical, behavioral, and social barriers and develop appropriate solutions.
• Monitor member progress and make adjustments to care plans, services, and providers when necessary.
• Identify and respond appropriately to member crisis situations.
• Advocate for members regarding benefit coverage, treatment options, healthcare access, and necessary services.
• Track quality-of-care and quality-of-life outcomes against established care plan goals.
• Maintain accurate and timely clinical documentation.
• Perform other duties and projects as assigned.

Requirements

• Associate Degree in Nursing (ADN) plus 3 years of clinical experience working with the health needs of the population served.
• Equivalent combination of education and experience may be considered if sufficient to successfully perform the essential duties.
• Current, unrestricted California Registered Nurse (RN) license REQUIRED.
• Valid driver's license, acceptable driving record, and current auto insurance, or another approved means of transportation, as the position may require community travel.
• Ability to work independently, exercise sound clinical judgment, and manage multiple cases and priorities.
• Strong written and verbal communication skills.
• Ability to work effectively with members, families, healthcare providers, community organizations, and multidisciplinary teams.

Qualifications

• Bachelor of Science in Nursing (BSN)
• Certified Case Manager (CCM)
• Public Health Nurse (PHN) certification
• Experience in home health, hospice, or skilled nursing facilities
• Experience with Level of Care Certification processes
• Experience working with older adults
• Public health nursing experience
• Bilingual proficiency in English and one of the following languages: Arabic, Farsi, Chinese, Korean, Russian, Spanish, or Vietnamese

Skills

• Case management and care coordination
• Clinical assessment
• Care planning and service coordination
• Crisis intervention
• Patient/member advocacy
• Interdisciplinary Team (IDT) collaboration
• Knowledge of medical, behavioral, and social needs of older adults
• Strong analytical and problem-solving abilities
• Ability to establish rapport with diverse populations
• Excellent organization and time-management skills
• Ability to work effectively in a fast-paced environment
• Proficiency with Microsoft Office, including Word, Outlook, Excel, and PowerPoint
• Ability to manage multiple priorities and collaborate across departments and external organizations

Schedule

Monday Friday, 8:00 AM 5:00 PM