Temp RN Case Manager

General Description Of Position

The RN Case Manager is responsible for providing on-going case management services for Santa Clara Family Health Plan (SCFHP) members. As a SCFHP member advocate, the RN Case Manager facilitates communication and coordination among all participants of the care team to ensure member identified goals and needed services are provided to promote quality cost-effective outcomes.

Essential Duties And Responsibilities

• Conduct, review and document comprehensive clinical and/or psychosocial assessments and on-going follow-up interventions to measure progress towards meeting goals as they relate to a member’s physical, psychosocial, environmental, safety, developmental, cultural and linguistic needs.

• Maintain case files by assuring that they are documented in accordance with SCFHP policies and procedures, state and federal requirements and organized in a manner that adheres to standards for audit requirements.

• Facilitate involvement of the member and/or family/responsible party for development and implementation of a member specific care plan which includes individualized prioritized goals.

• Career Development and Training: Participate in ongoing professional development activities to enhance skills and knowledge related to case management and managed care.

• Coordinate member’s care with PCP, Specialists, Behavioral Health and Long Term Services and Supports providers to assist member to achieve or maintain a level of functional independence which allows them to remain at home or in the community.

• Facilitate and coordinate communication with member’s interdisciplinary care team including SCFHP internal staff, as well as the member’s physicians, specialists, public services, community agencies and vendors to ensure care plan development and coordination of benefits and services.

• Facilitate successful transition of care for members who move between care settings by coordinating services for medical appointments, pharmacy assistance and by facilitating utilization review.

• If assigned to MLTSS, support the transition of long-term care members residing in nursing facilities to a lower level of care, or community setting in partnership with MLTSS providers and programs.

• If assigned to Community Based Adult Services (CBAS): Conduct face-to-face, on-site eligibility determinations for CBAS services with members using the standardized California Department of Health Services approved tool – CBAS Eligibility Determination Tool (CEDT) & Patient Health Record Quick Guide; Review and approve Individual Plan of Care for CBAS members; and Provide care coordination to targeted CBAS members including assessment, care plan implementation and care transitions.

• Collaborate with team members on cross-departmental improvement efforts, quality improvement projects, optimization of utilization management, and improvement of member satisfaction.

• Attend and actively participate in Health Services meetings, operational meetings, training and coaching sessions, including off-site meetings as needed.

Requirements

• Active California RN License without restriction.

• Minimum three years of experience in case management, discharge planning, or education or certifications, or equivalent experience.

• Knowledge of managed care principles and practices with emphasis in Utilization Management and/or Case Management.

• Clinical knowledge and critical thinking skills with the ability to assess individualized whole-person care needs necessary to develop an effective care plan.

• Ability to consistently meet accuracy and timeline requirements to maintain regulatory compliance.

• Spanish, Vietnamese, Chinese, or Tagalog language bi-lingual skills.

• Experience working with designated member population (e.g. behavioral health, seniors and persons with disabilities, children).

• Ability to work within an interdisciplinary team structure.

• Ability to conduct home, facility and other community-based visits.

• Maintenance of a valid California driver’s license and acceptable driving record, in order to drive to and from offsite meetings or events; or ability to use other means of transportation to attend offsite meetings or events.

• Maintain confidentiality.

• Ability to perform the job safely and with respect to others, to property and to individual safety.