RN CASE MANAGER -CALIFORNIA

Job Summary

Responsibilities

• Career Development: Encourages and supports professional growth.
• Coordinate and Manage Patient Care Plans: Assign and oversee patient care plans in California.
• Assess Patient Needs: Evaluate patient needs, eligibility, and required services for coverage.
• Monitor and Document Progress: Track patient progress, update care plans, and report outcomes.
• Ensure Compliance: Adhere to state regulations and organizational policies for case management.
• Collaborate with Healthcare Providers: Work with physicians, therapists, and community resources to secure services.
• Navigate Barriers to Care: Resolve issues such as referrals and authorizations.
• Educate Patients: Provide education on disease management, medications, and care expectations.
• Support On-Site Case Management: Facilitate timely service delivery through on-site support.
• Maintain Records: Keep accurate records for audits, billing, and quality assurance.
• Utilize Care Pipelines: Utilize and maintain care pipelines and dashboards for forecasting patient flow and outcomes.
• Participate in Reviews: Contribute to regular performance reviews and process improvements.
• Identify High-Potential Cases: Identify and prioritize high-potential cases to support growth targets.

Requirements

• RN License Valid in California: Hold a valid RN license in California.
• Current Nursing Practice Hours: Maintain current nursing practice hours.
• Experience in Case Management: Have experience in case management for medical or managed care settings.
• Knowledge of State Regulations: Possess strong knowledge of California state regulations for case management and privacy.
• Individualized Care Plans: Develop and monitor individualized care plans and progress notes.
• Barrier Navigation: Have proven skills in navigating and resolving barriers to care, including referrals and authorization processes.
• Data-Driven Forecasting: Be proficient with care pipelines, dashboards, and data-driven forecasting.
• Collaboration: Exhibit excellent collaboration with physicians, therapists, and community resources.
• Documentation and Record-Keeping: Demonstrate strong documentation, auditing, and billing record-keeping capabilities.
• Growth Mindset: Show a growth mindset with the ability to identify high-potential cases and contribute to targets.
• On-Site Presence: Require an on-site presence to provide support within California.