Job Description

Job Description:

Job Tittle: Care Manager I

Location: Remote

Duration: 2 Months Contract

Shift: 8AM 5PM (Mon-Fri) (PST)

Position Purpose:

• Perform care management duties to assess, plan and coordinate all aspects of medical and supporting services across the continuum of care for select members to promote quality, cost effective care.

Walk me through the day-to-day responsibilities of this the role and a description of the project (Outside of Workday JD):

• Outreaching member to enroll them in CM program
• Building care plans, medication review, assessments care plans

Describe the performance expectations/metrics for this individual and their team:

• 20 calls/day

Tell me about what their first day looks like:

• System-specific training

Responsibilities:

• Develop, assess and adjust, as necessary, the care plan and promote desired outcome.
• Assess the member's current health status, resource utilization, past and present treatment plan and services, prognosis, short- and long-term goals, treatment and provider options
• Coordinate services between Primary Care Physician (PCP), specialists, medical providers, and non-medical staff as necessary to meet the complete medical socio-economic needs of clients
• Develop plan of care based upon assessment with specific objectives, goals and interventions designed to meet member's needs
• Provide patient and provider education
• Facilitate member access to community-based services
• Monitor referrals made to community-based organizations, medical care and other services to support the members' overall care management plan
• Actively participate in integrated team care management rounds
• Identify related risk management quality concerns and report these scenarios to the appropriate resources
• Enter and maintain assessments, authorizations, and pertinent clinical information into various medical management systems

Education/Experience:

• Graduate from an Accredited School of Nursing. Bachelor's degree in Nursing preferred.
• 2+ years of pediatric clinical nursing experience in a clinical, acute care, or community setting. Knowledge of healthcare and managed care preferred.
• Florida residency required. Knowledge of healthcare and managed care preferred.
• Prior experience working in a remote role preferred.
• Prior case management experience preferred.
• Bilingual in Spanish and English is preferred.

Licenses/Certifications:

• Current state's RN license and CA RN License.

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