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Clinicas del Camino Real, Inc. · 1 week ago

General Case Manager (RN or LVN)

Camarillo, CA

Full-time

Onsite

Entry, Mid Level

$81K/yr - $96K/yr

1+ years exp

Clinicas del Camino Real, Inc. is seeking a General Case Manager (RN or LVN) to support their membership by performing care management duties. The role involves assessing, planning, and coordinating medical and social services for members identified as medium rising risk or high utilizers to promote quality outcomes.

DentalHealth CareMedicalMental Health

Hiring Manager

Leslie Ramos

Responsibilities

The case manager plays a primary role in working with medium rising risk members or high utilizers to improve their health outcomes through medical and social care coordination approaches, community engagement, and targeted programs to support the unique needs of each assigned case management member

Case management strategies will be driven by incorporating the member’s ethnicity, age, specific chronic health conditions, social designations such as SUDs, prisoners, survivors of abuse, and those with mental health issues

Assessment- involves a comprehensive collection of data and ongoing collaborative process of observation, information gathering, reflection and engagement with the client, and analysis of the client's overall situation and needs

Member Centric - actively participate in and are at the center of decision making and support planning. This fosters trust and ensures that the services provided align with the Members’ expectations and needs by Empowering them to take an active role

Planning to establish specific objectives and care goals, both short- and long-term, based on the client's needs identified earlier in the assessment process

Effective Communication •Individual CM• extends to writing concise and accurate reports, documentation, and referrals and leveraging technology to facilitate collaboration. •Members•utilize effective listening to understand the Member’s needs, concerns, and feedback, ensuring that they feel heard and respected

Care Team promote seamless communication among all team members supported by regular meetings and shared data methodologies

Conduct Regular Evaluations- Regularly evaluate the case management processes to identify strengths and pinpoint areas for improvement.Such as encourage regular client check-ins and perform ongoing updates and activities resulting from CM arrangements such as PCP, Specialty and Community encounters

Advocacy Skills . As the case manager, to advocate on behalf of assigned CM members to ensure they receive the services and support to promote quality CM outcomes

The Case Manager works within a team environment to:

Develop, guide and provide case management services by utilizing clinical expertise, and coordination efforts with the medical management team, community supports and contracted upstream health plan

Analyze medical trends and intervene with members identified to be at rising medium risk and/or high utilizers

Interact with members’ primary care physicians, and specialists to provide seamless case management activities across the care continuum

Interact with community/system resources, and maintain resource directories of collaborative and supporting agencies

Establish individualized member care plans that incorporate prioritized case goals, implementation plans, and ongoing measurement of outcomes

Access and utilize data from various data systems to create a comprehensive member case file that is supported with member assessments, clinical reports, encounters, community appointments, medication management, and identified SDOHs

Collaborate with healthcare professionals to assess, plan, and coordinate patient care needs

Participate in quality improvement activities to enhance clinical outcomes and resource utilization

Collect and analyze patient information for third-party vendors

Arrange or participate in member case conferences internally at CDCR, externally with GCHP and community agencies

Submit timely progress reports and updated member care plans and profiles as necessary to support continuum in the member’s case management process

Performs telephonic assessment to assess member needs and collaborate with resources and provides education/support for treatment regimen adherence and medication management to support self-management and independent living

Identifies potential care gaps and makes referrals as appropriate

Identifies available community services and health resources and facilitates access to care and services available to patient/family when needed

Collects, documents, and maintains all member information and care management activities to ensure compliance with current state, federal, and third-party payer regulations

Makes referrals for Complex Case Management, Enhanced Case Management, or Basic Case Management

Provides feedback to leadership on opportunities to improve and enhance care and quality delivery for members in a cost-effective manner

Attends all required team/staff meetings

Performs other duties as assigned by people leader to meet business needs

Qualification

Registered Nurse (RN)Licensed Vocational Nurse (LVN)Case ManagementCertified Case Manager (CCM)Health Education CertificationSpanish SpeakingAdvocacy SkillsEffective CommunicationTeam Collaboration

Required

Completion of an accredited Registered Nurse (RN) program or accredited Licensed Vocational Nurse (LVN) or Licensed Practical Nurse (LPN) Program

1-3 years in case management, disease management, managed care or medical or behavioral health settings

Valid RN or LVN/LPN license is required for the job. License must be active, unrestricted and in good standing

A valid driver's license with good driving record and be able to drive within applicable state or locality with reliable transportation

Preferred

3-5 years in case management, disease management, managed care or medical or behavioral health settings

Spanish speaking preferred

Certified Case Manager (CCM) or Certified in Health Education and Promotion (CHEP)

Company

Clinicas del Camino Real, Inc.

Clinicas del Camino Real, Inc. has been providing quality primary and preventative health care services to the residents of Ventura County since 1971.

Founded in 1971

Camarillo, California, USA

501-1000 employees