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Case Management Nurse

Company: CenCal Health
Location: Santa Barbara
Posted on: March 9, 2019

Job Description:

Location: Santa Barbara, California, , United StatesJob ID: 47108040Posted: 03/04/2019Position Title: Case Management NurseCompany Name: CenCal HealthSector: HospitalEntry Level: falseFull-Time
Santa Barbara, CA, USA
Req Number: CASEM01076

This position is responsible for coordinating and managing specific CenCal Health members for defined periods of time and/or post discharge transition from an inpatient setting (e.g. acute care hospital, skilled or long-term care facility) to ensure that member's outpatient care is being coordinated and that all medically necessary services are being provided in a timely manner. In addition, this position requires the management of complex care members over longer periods as deemed appropriate, as well as seniors and persons with disabilities, and potentially preventable admissions.

Responsibilities include, but are not limited to:

  • Coordinate the provision of quality and cost-effective health care services
  • Coordinate care and services for members and effectively and efficiently implement and complete the care management process. This process involves health screening, assessment, planning, coordination of care, and monitoring of member's progress and compliance
  • Collaborate with the member, the member's family or caretaker, primary care provider, and other health care providers
  • Coordinate timely care transition from one level of care to another, such acute to SNF or SNF to home or other living arrangement as the member's care needs change
  • Effectively communicate and educate members about the health care delivery system and health plan benefits and limitations
  • Identify care needs of the member, identify interventions, develop plan of care, implement necessary services, and establish timelines for case management services
  • Effectively communicate verbally and in writing with primary care providers and other health care providers involved in the member's care
  • Adhere to Health Plan and department specific policies and procedures Qualifications

    Experience Required:

    • Current active, unrestricted California Registered Nurse License with a minimum 2 years' experience as a Registered Nurse
    • Prior UM/CM experience in a managed care setting
      • Valid California Driver's License with a clean driving record
      • Proficient with computer and Microsoft Office, Word, Excel, PowerPoint
      • Certification in case management, utilization review, or healthcare management desired
        To Apply and Learn More: PI108292225

        Keywords: CenCal Health, Santa Barbara , Case Management Nurse, Executive , Santa Barbara, California

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