Case Manager-RN-CPSP - Lamont CHC

Clinica Sierra Vista•Lamont, CA

6d•Onsite

About The Position

Clinica Sierra Vista is seeking a Case Manager RN CPSP to join their team. This role collaborates with Community Patient Health Workers (CPHWs) and healthcare providers to ensure high-quality patient care. The position involves reviewing CPHW documentation, monitoring lab results, coordinating provider orders in the EHR, and providing health education to pregnant patients in the Comprehensive Perinatal Services Program (CPSP). The RN is crucial in coordinating care and improving maternal and fetal health outcomes.

Requirements

AA/AS in a health, social science or related field required and/or graduation from an accredited School or License in Registered Nursing.
Must have a license from the California Board of Nursing preferred.
Minimum one-year relevant work experience in related field and/or minimum two years nursing experience (ambulatory/obstetrical nursing preferred).
Knowledge of community resources desirable.
Knowledge of socio-economic environmental and cultural factors affecting patient’s health care.
Ability to work effectively in an interdisciplinary team approach with both professionals and paraprofessionals.
Ability to communicate effectively both orally and in writing with persons from diverse social, economic and cultural backgrounds.
Ability to maintain patient dignity and confidentiality.
Minimum of one-year supervisory experience.
Committed to the belief in health care with dignity for all, and that people have the right to health care information and participation in planning their own health care.
Must adhere to Clinica Sierra Vista’s employee health/immunization requirements or provide a valid exemption request for subsequent approval.

Nice To Haves

Bilingual and biliterate in Spanish desirable.
Willingness to work non-regular hours as required.

Responsibilities

Case coordination of Obstetric patients enrolled in CPSP services as directed by the Women’s Health Director, California Department of Public Health and CPSP protocols.
Educate patients enrolled in CPSP with up- to- date information, providing higher quality of care.
Facilitate implementation of changes in evidence-based care as it relates to Maternal Health.
Review prenatal records for high-risk factors and follow direction of Obstetric Provider to determine level of care appropriate for the patient.
Assess patient Obstetric, Medical and Family history for any concerns that increase risk to pregnancy and forward to Obstetric Provider for review.
Provide patient education regarding access to prenatal care from outside agency if patient’s pregnancy deemed high- risk requiring a higher level of care.
Ensure the Individualized care plan is complete and appropriate for patient needs, assess effectiveness of interventions and modify care plan as needed.
Ensure patient receives integrated care that addresses patient needs and promotes patient involvement.
Assess psychosocial, nutrition and health education need of the patient and ensure appropriate community resources and referrals provided, including but not limited to, housing, transportation, behavioral health, dental, genetic screening, and intimate partner violence.
Assess patient weight gain in pregnancy and refer to nutrition services as needed
Provide patient education on risk factors for the pregnancy and prevention of complications.
Assess patient understanding. taking into consideration language barrier, education level, presence of any disabilities, cultural and gender diversity.
Collaborate with Obstetric Provider regarding patient care plan.
Function as the liaison between the patient and the health care team to promote effective communication.
Educate patients on the purpose for testing, labs and interventions.
Educate patients on risk factors in which Perinatology consultation is ordered by OB Provider and assess patient’s understanding of importance in attending.
Track patient attendance at appointments and assess barriers to prenatal care utilization.
Participate in case conferencing on the 4th Tuesday of the month and Residency OB team lead meeting monthly and weekly with preferred Perinatologist.
Provide assistance to Residency OB team and attend Didactics as needed for presentations
Other duties as required.