Care Manager, RN - Health Access, ECM - Rancho Cucamonga (Remote)

Inland Empire Health Plan•, CA

40d•$91,250 - $120,910•Remote

About The Position

This position is responsible for working effectively with the Health Access Enhanced Care Management (ECM) Care Coordination team, members and families, other professionals, and the designated healthcare care organization (HCO) medical team to provide high quality, effective care management to IEHP members. This position focuses on a person-centered model of care which takes into account the member’s medical, behavioral, and social needs. This position provides high quality, effective care management to IEHP members ensuring coordinated continuous care. Care Management is broadly defined, and can include outreach and engagement to members, engaging members in skilled therapeutic interactions to promote health behaviors, other behavioral health interventions within scope, coordination of care, resource linkages, working with other professionals, and organizations in the community to ensure quality of care for members, seamless transitions of care, and facilitating the right care and the right time for the member. As a licensed clinician, this position provides clinical expertise, clinical leadership, and clinical oversight in a variety of ways within the Enhanced Care Management program. This position, like all positions within the HA ECM team, is expected to model behavioral health principles of relationship-based care, as well engage in promoting education and understanding of behavioral health and its importance in whole health, to those within IEHP and in the community. This is a field-based position in which Care Team Members will meet with our highest risk/high utilizer population face to face, per member's consent. The individual in this position is to utilize their clinical expertise to support and engage members to promote positive health behaviors, assist with coordination of care, provided resource linkages, and collaborate with other Team Members within their care team, as well as external partners, to ensure a seamless transition of care experience. The IEHP Team is committed to incorporate IEHP’s Quality Program goals including, but not limited to, HEDIS, CAHPS, and NCQA Accreditation.

Requirements

Three (3) or more years of care management experience in a health care delivery setting required.
Experience working successfully within a team, and experience in developing and maintaining effective relationships with both clients and coworkers is mandatory
Associate’s degree in Nursing from an accredited institution required
Possession of an active, unrestricted, and unencumbered Registered Nurse (RN) license issued by the California BRN required
Must have a valid California Driver’s license and valid automobile insurance. Must qualify and maintain driving record to drive company vehicles based on IEHP insurance standards of no more than three (3) points
Strong knowledge and in-depth understanding of: Skill in evidenced based communication such as Motivational Interviewing, or similar empathy-based communication strategies
Understanding of and sensitivity to multi-cultural community
Self-management philosophies and practices, especially as they relate to chronic medical conditions
Awareness of the impact of unmitigated bias and judgement on health; commitment to addressing both
Highly skilled interpersonally, with excellent relationship skills
Highly skilled in interpersonal communication, including resolving conflict with co-workers
Skillful in informally and formally sharing expertise
Must have skills to tolerate, manage and make effective use of a high level of ambiguity around new team models, new models of care, and new care management practices

Nice To Haves

Experience in a Managed Care setting preferred
Minimum of one (1) year clinical experience in an acute care facility, skilled nursing facility, home health or clinic setting preferred
Adults, unaccompanied youth & children, and families experiencing homelessness
Adults, youth, and children who are at risk for avoidable hospital or ED care
Adults, youth, and children with serious mental health and/or substance use disorder needs
Adults living in the community and at risk for long-term care institutionalization
Adult nursing facility residents transitioning to the community
Children & youth enrolled in CCS or CCS Whole Child Model with additional needs beyond their CCS conditions
Children & youth involved in child welfare (foster care)
Adults & youth who are transitioning from incarceration
Pregnant & postpartum individuals; birth equity population of focus
Bachelor’s degree in Nursing from an accredited institution preferred
Certified Case Manager (CCM) preferred
Bilingual (English/ “Target Language”) preferred

Responsibilities

Exercise independent clinical judgment and strategic planning in managing a caseload of members with medical needs according to department processes and procedures.
Recommend care coordination strategies for members, including but not limited to: Utilize clinical tools and metrics (i.e., brief medical interventions) as necessary to inform interventions, manage caseloads, and escalate high-risk cases appropriately.
Engage with members, both in-person and on the phone, in a manner that utilizes evidence-based approaches (such as Motivational Interviewing) that promotes collaboration between the member and his or her medical/behavioral team, as well as improving the member’s ability to manage and control their whole health.
Conduct comprehensive, holistic assessment according to the scope of the RN license.
Assimilate assessment information into an individualized care plan (ICP), communicate ICP with members, approved family or caregiver, and other members of the care team.
Lead inter/transdisciplinary care team meetings to share information, update and inform care plan
Coordinate with internal and external health partners to support Members comprehensive care needs
Participate and lead care transition plan responsibilities
Assist with the coordination of medical and behavioral health access issues with PCP offices, specialists, and ancillary services
Coordinate care for members with complex medical and social needs, including across the physical, behavioral, and dental health delivery systems
Provide formal and informal training and support for Health Access Team Members on medical conditions, including treatments and evidence-based for treatment.
Provide clinical consultation and support for Health Access ECM Team Members on physical health conditions, including evidence-based care
Represent the Enhanced Care Management team as the lead member when necessary
Develop interventions to improve the member’s ability to manage their own health
Support the clinical scope of responsibilities for non-clinically licensed care Team Members within the RN scope of practice
Cultivate and sustain productive partnerships with providers, team members, and community stakeholders. Employ advanced communication methods to strengthen collaboration across in-person, telephonic, and digital platforms. Model supportive and collaborative relationships with Members, co-workers, and community relations
Promote a collaborative and effective working environment within the Health Access Enhanced Care Management team by engaging in evidenced-based communication strategies (such as Motivational Interviewing) when discussing responsibility/sharing of tasks, effectively resolving conflicts as arise, and collaborating on Member case discussions
Model the highest ethical behavior in relationships with co-workers, supervisors, Members, Providers, and colleagues in the community
Model commitment to continuous quality improvement by engaging in quality improvement initiatives and projects, such as identifying and addressing performance indicator measures, HEDIS gaps, and other quality measures
Participate in staff meetings, trainings, committee meetings, or other activities as needed or as directed by Leadership
Ensure documentation is accurate and in compliance with regulatory requirements and accreditation standards
Perform any other duties as required to ensure Health Plan operations and department business needs are successful