Care Manager – Registered Nurse

COPE Health Solutions•Downtown Los Angeles, CA

7d•Remote

About The Position

The Care Manager Registered Nurse (RN) serves as a key clinical member of the interdisciplinary care team in the Care at Home Solutions program. The RN partners with the Medical Director, Advanced Practice Provider, Licensed Clinical Social Worker, Community Health Worker, Pharmacist, Care Navigators, primary care providers, and community partners to coordinate care for patients with complex medical, behavioral, and social needs. The role develops and implements individualized care plans, provides clinical assessment and education, conducts telephonic and in-home care management visits as appropriate, supports transitions of care, and collaborates with primary care providers to improve quality, patient experience, and health outcomes. The Care Manager RN helps reduce avoidable utilization, address barriers to care, and support patients in managing chronic conditions. The position is remote in Los Angeles, California, with travel up to 50%; the work environment also involves in-home patient visits roughly 50% of the time and otherwise is based in the LA office. The position is part-time, regular, and non-exempt, and reports to the Medical Management Director. It has direct reports.

Requirements

Current RN license; California licensure is preferred in addition.
Associate degree in nursing is the minimum education requirement.
1–2 years of experience in acute inpatient, rehabilitation, sub-acute, skilled facility, home care, ambulatory care management, or managed health plan settings.
Working knowledge of utilization management principles, care management principles, health plan contracts and benefit eligibility requirements, hospital structures, managed care, and payment systems.
Ability to document day-to-day activities accurately and on time in a designated technology platform.
Ability to adapt to new technologies and software.
Ability to use independent judgment and manage confidential information.
Ability to analyze information and solve problems, examining details, data, and facts before making decisions.
Strong communication and interpersonal skills, including the ability to clearly communicate medical information to professional practitioners and/or the public.
Strong organization, prioritization, follow-up, analytical, and time-management skills, including the ability to manage multiple priorities and deadlines.
Dependability, a strong work ethic, personal integrity, initiative, ownership, and a sense of urgency.
Ability to handle frequent interruptions while maintaining friendly interactions.
Ability to develop and implement approaches to improve processes, procedures, or the general work environment.
Ability to review critical issues, solve problems effectively, and create action plans.
Ability to make in-home patient visits; the role requires travel up to 50%.

Nice To Haves

Bachelor’s degree in nursing.
Certified Case Management (CCM) certification.
Care or case management experience.
Proficiency in EMR systems.
Outlook and data-entry experience.
Basic PC skills, including MS Word, Outlook, PowerPoint, and Excel.

Responsibilities

Evaluate patients for care management services and determine the appropriate level of care coordination and management.
Complete comprehensive assessments to identify patient risk and develop care plans, using clinical expertise and judgment to evaluate needs for alternative services.
Collaborate with physicians and in-house resources, including pharmacists, registered dieticians, social workers, and other disciplines, to create person-centered care plans with measurable SMART goals.
Monitor and update care plans, including progress toward goals and patient self-management activities.
Work with patients, families, providers, and the interdisciplinary care team to assess care options, benefits, and community resources, and update care plans.
Use established systems, processes, and initiatives to engage patients in case management activities that promote wellness and care in the appropriate setting and time.
Support patient adherence to the medical plan of care through collaboration with physicians and in-house resources.
Supervise and serve as a resource for non-clinical staff, including care coordinators and social workers.
Verify that home care, hospice care, and other ancillary services, such as DME and infusion services, are in place and delivered as directed by the care team.
Coordinate necessary referrals and authorizations within care management areas.
Facilitate information flow among hospitals, long-term care facilities, specialists, home health representatives, and the care team.
Use available data and collaborate with physicians and office staff to identify high-risk, high-need, and potentially high-cost patients.
Coordinate care and communicate with multiple providers, both internal and external to the practice.
Identify and use cultural and community resources, aligning care with patient cultural preferences as much as possible.
Verify that members are screened for behavioral health concerns, including depression and substance abuse, and receive appropriate screening and interventions; facilitate follow-up with local behavioral health providers as needed.
Attend required training and collaboration sessions, including learning sessions, care management meetings, and practice team meetings.
Maintain open communication about patient status with physicians and office staff.
Obtain records from other physicians, laboratories, and diagnostic centers as requested by physicians and needed for care coordination.
Develop constructive relationships with internal population health team members, participating providers, and community resources.
Perform other job-related duties as assigned.