Care Manager, RN -Hybrid

Inland Empire Health Plan•Rancho Cucamonga, CA

3d•Hybrid

About The Position

Overview What you can expect! Find joy in serving others with IEHP! We welcome you to join us in “healing and inspiring the human spirit” and to pivot from a “job” opportunity to an authentic experience! Reporting to Health Services department leadership, this position is responsible for working effectively to provide high quality, effective care management to IEHP members. 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. This position works collaboratively with members of the Integrated Care Team, members and families, and other professionals, in addition to working collaboratively with the designated health care organization’s (HCO) medical team. This position, like all positions within IEHP, is expected to model whole health principles of relationship-based care, as well engage in promoting education and understanding of physical health and healthy behaviors to those within IEHP and in the community. Commitment to Quality: The IEHP Team is committed to incorporate IEHP’s Quality Program goals including, but not limited to, HEDIS, CAHPS, and NCQA Accreditation. Additional Benefits Perks IEHP is not only committed to healing and inspiring the human spirit of our Members, but we also aim to match our team members with the same energy by providing prime benefits and more.

Requirements

Minimum two (2) years clinical experience in an acute care facility, skilled nursing facility, home health or clinic setting required
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
Knowledgeable and skilled in evidenced based communication such as Motivational Interviewing, or similar empathy-based communication strategies
Understanding of and sensitivity to multi-cultural community
Deep understanding and knowledge of 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
Must have knowledge of whole health and integrated principles and practices
Highly skilled in interpersonal communication, including conflict resolution
Effective written and oral communication skills, as well as reasoning and problem-solving skills
Skillful in informally and formally sharing expertise
Must have the resiliency to tolerate and adapt to a moderate level of change and development around new models of care and care management practices
Proficient in the use of computer software including, but not limited to, Microsoft Word, Excel, PowerPoint
Demonstrated proficiency with all electronic medical management systems (e.g., Cisco, MHK/Care Prominence, MediTrac, SuperSearch and Web Portal) is preferred
Proven ability to: Sufficiently engage members and providers on the phone as well as in person
Work as a member of a team, executing job duties and making skillful decisions within one’s scope
Establish and maintain a constructive relationship with diverse members, leadership, Team Members, external partners, and vendors
Prioritize multiple tasks as well as identify and resolve problems
Have effective time management and the ability to work in a fast-paced environment
Be extremely organized with attention to detail and accuracy of work product
Have timely turnaround of assignments expected
To form cross-functional and interdepartmental relationship

Nice To Haves

Two (2) or more years of care management experience in a health care delivery setting preferred
Experience in a Managed Care (HMO, IPA) or in acute facility (i.e. hospital) care management preferred
Bachelor’s degree in Nursing from an accredited institution preferred
Bilingual (English/Spanish) preferred

Responsibilities

Exercise independent clinical judgment and strategic planning in managing a caseload of members with complex medical and behavioral health needs according to department processes and duties.
Recommend care coordination strategies for members, including but not limited to, the following: Apply brief medical/behavioral interventions and evidence-based methodologies as necessary to enhance the member’s ability to manage their own health.
Lead the development of individualized care plans (ICPs) or discharge plans through comprehensive biopsychosocial assessments and interdisciplinary collaboration.
Develop and communicate ICP with the member, approved family or caregiver and other members of the care team.
Facilitate and guide interdisciplinary care team meetings, influencing care plan modifications and alignment with member goals.
Review and revise contributions to assessment information and care planning from care team members (i.e. LVN Care Manager, Care Coordinator) as appropriate.
Initiate and oversee quality improvement initiatives and projects that address clinical gaps (e.g., HEDIS measures), improve health outcomes, and support innovation.
Identify, develop, and test new practices for improving member health outcomes.
Advocate for timely, high-quality care for members by coordinating with internal partners and external providers across the continuum of services.
Utilize clinical tools and metrics (e.g., PHQ scores, ER visit trends, hospitalization trends, substance use trends) to inform interventions, manage caseloads, and escalate high-risk cases appropriately.
Design transitional care strategies for members shifting between care settings, ensuring coordination of services such as home health, DME, and primary care follow-up.
Implement targeted outreach approaches to support care continuity, promote resource linkage, and empower member self-efficacy across care transitions.
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.
Ensure clinical documentation adheres to all applicable state, federal, and accreditation standards.
Drive audit readiness and reporting integrity through proactive compliance oversight.
Serve as a subject matter resource by providing formal and informal education to peers and cross-functional staff on medical conditions, treatment protocols, and emerging evidence in behavioral/medical health care.
Participate in staff meetings, trainings, cross-functional committees, department planning initiatives, and professional conferences to represent Medical and Behavioral Health perspectives and contribute to strategic alignment with organizational goals.
Perform any other duties as required to ensure Health Plan operations and department business needs are successful.