RN Outpatient Case Manager – Medical Group

Location: Oakland, CA
Date Posted: 02-01-2018
Outpatient Case Management Nurse (RN) – Managed Care 
Oakland, CA
** Hospice Case Management Experience is Ideal = Great Opportunity to open the door to Managed Care Organizations **

Your Job Summary:
As a member of the medical management team, the Nurse Outpatient Case Manager plays an integral part in the coordination of care assessing the member’s condition and providing them the necessary resources, options, and coordination for a healthy care outcome. The primary responsibility of the Nurse Case Manager is to coordinate and monitor the care of Health Plan members and develop a nursing plan of care. They will participate in interdisciplinary conferences to review clinical assessments, update care plans and determine follow-up frequency. The Case Manager also acts as an advocate for members and their families linking them to other members of the care team to help them gain knowledge of their disease process and to identify community resources for continued growth toward a maximum level of independence.
Your Reward:  
Work with an exceptional organization focused exclusively on promoting the health care and quality of life for its members.  The forward-looking health plan has a demonstrated passion for finding innovative ways to enhance member’s ability to manage their own health.
Your Background: 
Valid, unrestricted state Registered Nurse (R.N.) license.
Certification in Case Management (CCM) is preferred.
Around 2-3 years acute care clinical nursing experience. 
Roughly 3-5 years experience with care coordination, utilization review and/or discharge planning.
​At least 1-3 years of Outpatient Case Management experience is required, preferably in a Hospice setting.
Prefer, but does NOT require 1-2 years at a Managed Care Organization (Health Plan/HMO/MSO/TPA/IPA/etc).
Experience working with Federal and State assistance programs (Medicare/Medicaid/ect)
Computer literacy (MS Office) and typing skills are necessary.
Working knowledge of Milliman or InterQual criteria.
Strong oral and written communication skills; ability to interact within all levels of the organization as well as with external contacts.
Must be able to prioritize, plan, and handle multiple tasks/demands simultaneously.
Your Duties:
The Nurse Case Manager will serve the daily case management needs of members. This includes administering all provider resources through the care continuum, from the initial referral through discharge and ensuring compliance with the plan of care. They will collaborate effectively with an interdisciplinary team to establish an individualized plan of care for members. A strong emphasis is placed on Wellness, Disease Management and patient/member education to ensure compliance with the plan of care and prevention of complications with various ailments. The Case Manager will develop interventions and processes to assist the Health Plan member in meeting short and long term plan of care goals.  They will coordinate member visits with PCP and specialists as needed. Communication of patient needs will be conducted through timely and accurate data entry into designated care management applications. The Case Manager will participate in the development of appropriate QI processes, establishing and monitoring indicators. Utilizing their knowledge of health plan benefits and provider network including inclusions and exclusions in contract terms, the Nurse will help guide physicians in their awareness of preferred contracts, providers, and facilities.  Additionally, the Nurse Case Manager will integrate utilization management activities for patients enrolled in the patient-centered case management program and will communicate with interdisciplinary treatment teams to develop and maintain positive working relationships with patients, families and providers.  Identify potentially catastrophic, complex cases that require case management intervention by applying professional judgment and collaborate with internal and external resources to co-manage complex cases and those that require behavioral health case management intervention.  They will coordinate the approved services with all provider staff under the specific direction of the Medical Director or Manager of Medical Management.
CareNational Healthcare Services
480.478.1635 (CALL – TEXT – FAX)

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