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Pediatric CM Nurse Coordinator - Bilingual Required (1 position)

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

Job Description:

Location: Santa Barbara, California, , United StatesJob ID: 47108158Posted: 03/04/2019Position Title: Pediatric CM Nurse Coordinator - Bilingual Required (1 position)Company Name: CenCal HealthSector: HospitalEntry Level: falseFull-Time
Santa Barbara, CA, USA
Req Number: PEDIC01022

Pediatric CM Nurse Coordinator - Bilingual Required (1 position)

DescriptionThis CM Nurse Coordinator 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, 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, care planning, coordination of care, and monitoring of member's progress and compliance
  • Collaboratively develop realistic individualized care plan with member and their family
  • Perform concurrent review of hospitalized member
  • Assist with discharge planning and care transitions from one care setting to another
  • Process service requests and specialty referrals in a timely manner
  • 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 Qualifications

    • Outlook: Intermediate
    • Microsoft Office: Intermediate


      • Bi-lingual-English and Spanish - 1 position only
      • Current, Active RN License
      • 2 years: Registered Nurse in outpatient, inpatient or office setting

        • Prior UM/CM experience in a managed care setting
        • Certification in case management, utilization review or healthcare management
        • 1 year: Clinical Experience working with pediatric population

          Apply and Learn More: PI108292223

          Keywords: CenCal Health, Santa Barbara , Pediatric CM Nurse Coordinator - Bilingual Required (1 position), Other , Santa Barbara, California

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