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Case Management Nurse - No Nights Or Weekends!

Company: CenCal Health
Location: Santa Barbara
Posted on: November 25, 2018

Job Description:

Location: Santa Barbara, California, 93101, United StatesJob ID: 45102823Posted: 11/20/2018Position Title: Case Management Nurse - No Nights Or Weekends!Company Name: CenCal HealthSector: HospitalEntry Level: falseJob Type: Full-TimeMin Experience: 2-3 YearsCase Management Nurse

Shift: Monday-Friday 8:00-5:00
Classification: Exempt
Department: Health Services

Looking for a career that makes a difference in people's lives? CenCal Health is a locally-run, not-for-profit health plan that serves nearly 180,000 people, with offices in both Santa Barbara and San Luis Obispo Counties. For 35 years, we've been improving the health and well-being of our neighbors through partnership and collaboration, and we're looking for exceptional, mission-driven professionals to help us grow. We are an employer of choice in Santa Barbara, offering competitive salaries, generous vacation & holidays, comprehensive health/dental/vision benefits including a CalPERS pension plan and 457 deferred income plan, a wellness program, a gym in our headquarters and parking lot BBQs. Come join our group of nice people doing good work at a great company.

Job Summary
Case management is a collaborative process that assesses, plans, implements, coordinates, monitors, and evaluates the options and services required to meet the client's health care needs and to the extent possible, meet their social needs. It is characterized by advocacy, coordination, communication, and resource management and promotes quality and cost-effective interventions and outcomes/goals. The CenCal Health CM Nurse is responsible for the above by assisting members who qualify for case management services with care coordination, which includes advocating medically necessary services for the member, facilitating care transitions, and communicating with providers to assure the medical needs of the member are being met. The goal of case management is to assist members with optimizing their wellness level and improve or maintain their functional capabilities by empowering them with education and self-managing tools, and assisting with care coordination or care transition.

Duties and ResponsibilitiesThis 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
  • Collaborate with contracted agencies and community based organizations to provide supportive services when needed (VNA- home nursing, PT, Meals on Wheels etc.)
  • Support and collaborate with the management and health services team members in the implementation and management of CM activities
  • Actively participate in the development, implementation and evaluation of department initiatives with the intent to assess and evaluate any measurable improvements to member's quality of care
  • Other duties as assigned Skills/Knowledge/Abilities (Indicate Required or Desired)

    • Excellent written, oral and interpersonal communication skills
    • Good computer literacy and skills
    • Strong analytical and problem-solving skills
    • Proficient multi-tasking and organization skills
    • Understand complex health care regulations such as HIPAA Privacy Rule
    • Ability to adhere to and apply principles and professional standards of practice established by the Case Management Society of America (CMSA)
    • Knowledge of Medi-Cal and/or Medicare Advantage plans, managed care regulations, including benefits and contract limitations, delivery and reimbursement systems, and role of medical management activities
    • Ability to work effectively in a cross-functional team environment in a collaborative way
    • Ability to work independently or collaboratively as a team member
    • Ability to communicate by phone and in person (in both individual and group situations) and to clearly and effectively communicate verbally and in writing
    • Ability to compose clear, professional, and grammatically correct correspondence to members and providers
    • Ability to negotiate with members and their families, physicians and other health care providers to develop realistic, member-centered care plans
      Preferred:Ability to use an electronic database, such as Essette or EPIC to document notes and develop care plans

      Education and Experience
      • Current active, unrestricted California Registered Nurse License with a minimum two (2) years' experience as a Registered Nurse
      • Valid California Driver's License with a clean driving record needed
      • Proficient with computer and Microsoft Office, Word, Excel, PowerPoint
      • Strong organizational skills and excellent verbal and written communication skills
      • Desired:
      • Certification in case management, utilization review, or healthcare management
      • Prior UM/CM experience in a managed care setting
        Essential Functions:
        • Physical requirements needed to perform the essential functions of this job, with or without accommodation:
          • Mobility Requirements: ability to operate a keyboard and sit for long periods; stand, sit, reach, bend, crawl, stoop, lift up to ten (10) lbs.
          • Visual Requirements: ability to read close-up and do close-up work
          • Dexterity Requirements: ability to perform repetitive motion (keyboard); writing (note-taking)
          • Hearing/Talking Requirements: ability to hear normal speech, hear and talk on the telephone
          • Emotional/Psychological Requirements: ability to deal with public contact, in person, and within a normal office environment. Must be able to sit and work at a computer for long periods of time
          • Must be able to travel outside the office and attend meetings during and after regular work hours
          • Regular attendance is essential to perform this job
          • Possess a current, valid driver's license with a clean driving record
            Find Out More About CenCal Health

            The above information on this description has been designed to indicate the general nature and level of work performed by employees within this classification. It is not designed to contain or be interpreted as a comprehensive inventory of all duties, responsibilities, and qualifications required of employees assigned to this job.PI105799475

            Keywords: CenCal Health, Santa Barbara , Case Management Nurse - No Nights Or Weekends!, Healthcare , Santa Barbara, California

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