Case Management Nurse (RN) - Managed Care
Rancho Cucamonga, CA
Case Manager Job Summary:
The 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 conduct health assessments, and then 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.
The focus of this position is to identify vulnerable populations and special needs members through the completion of health screens and other resources.
Case Manager Background:
Valid, unrestricted state Registered Nurse (R.N.) license. BSN is a plus.
Certification in Case Management (CCM) is preferred.
Around 2 years acute care clinical nursing experience in an acute care facility, skilled nursing facility, home health or clinic setting.
At least 2-4 years prior experience working in a Care Coordination / Case Management role.
Prefer around 1-3 years prior experience at a Managed Care Organization (Health Plan, IPA, MSO, TPA, etc).
Experience working with Federal and State assistance programs (Medicare/Medicaid/etc).
Basic computer literacy (MS Office) and typing skills are necessary.