Care Manager – Registered Nurse

COPE Health Solutions•Los Angeles, CA

13d•$38 - $53•Remote

About The Position

The Care Manager Registered Nurse (RN) is a clinical member of the interdisciplinary team in the Care at Home Solutions program. The RN works closely with the Medical Director, Advanced Practice Provider, Licensed Clinical Social Worker, Community Health Worker, pharmacist, and care navigators to coordinate care for patients with complex medical, behavioral, and social needs. The role develops and implements individualized care plans, conducts clinical assessments and education, provides 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 part time and regular, based remotely in Los Angeles, California, with travel up to 50%. The work environment includes in-home patient visits roughly 50% of the time; otherwise, the role is based in the Los Angeles office.

Requirements

Associate degree in nursing is the minimum education requirement.
Registered Nurse license; California licensure is preferred.
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 promptly in a designated technology platform.
Ability to adapt to new technologies and software.
Basic PC skills, including MS Word, Outlook, PowerPoint, and Excel.
Ability to use independent judgment and manage confidential information.
Ability to analyze and solve problems using details, data, and facts before making decisions.
Strong communication and interpersonal skills, including the ability to explain medical information clearly to practitioners and the public.
Strong organization, prioritization, follow-up, analytical, and time-management skills, including the ability to manage multiple priorities and deadlines.
Good interpersonal skills, a sense of urgency, a proactive approach, and ownership of work.
Dependability, a strong work ethic, and a high degree of personal integrity.
Ability to respond to continual interruptions with friendly, professional interactions.
Ability to develop and implement approaches to improve processes, procedures, or the work environment.
Ability to review critical issues, solve problems effectively, and create action plans.

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.

Responsibilities

Evaluate patients for care management services and determine the appropriate level of care coordination and management.
Conduct comprehensive assessments to identify patient risk and develop care plans, using clinical expertise and judgment to assess the need 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 established goals and 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 accordingly.
Use established systems, processes, and initiatives to engage patients in case management activities that promote wellness and care in the right setting and at the right time.
Collaborate with physicians and in-house resources to support patient adherence to medical plans of care.
Supervise and serve as a resource for non-clinical staff, such as care coordinators and social workers.
Verify that appropriate home care, hospice care, and ancillary services, including DME and infusion services, are in place and delivered as directed by the care team.
Coordinate 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 work with physicians and office staff to identify high-risk, high-need, and potentially high-cost patients.
Coordinate care and communicate with multiple internal and external providers.
Identify and use cultural and community resources, aligning them with patients’ 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 behavioral health interventions.
Facilitate necessary behavioral health follow-up with local providers.
Attend scheduled training and collaboration sessions, including learning sessions, care management meetings, and practice team meetings.
Maintain open communication with physicians and office staff regarding patient status.
Obtain records from other physicians, laboratories, and diagnostic centers as requested by physicians and needed for care coordination.
Build constructive relationships with internal population health team members, participating providers, and community resources.
Perform other job-related duties as assigned.