Catastrophic Case Manager - Southern CA (Must live in L.A.)

SCM Associates•Lynwood, CA

4d•Hybrid

About The Position

The Case Manager has the responsibility to identify, assess, plan, coordinate, implement, monitor, and evaluate options and services for individuals requiring case management services. The goal of the case manager is to provide for quality, cost-effective outcomes for the client through collaboration and communication with the client, the family, the physician, and other members of the health care team. The case manager typically works from their home office, and attends several patient appointments in person per week. Local/Regional driving is required.

Requirements

Registered nurse
BSN preferred
CCM or equivalent certification
Three years or more of related experience and/or training or equivalent combination of education and experience
Ability to read, analyze, and interpret medical information, professional journals, technical procedures, governmental regulations, and standards of care
Ability to effectively present information and respond to questions from customers, managers, and clients as appropriate
Ability to add, subtract, multiply, and divide in all units of measure, using whole numbers, common fractions, and decimals
Ability to compute rate, ratio, and percent and to draw and interpret bar graphs
Ability to solve practical problems and deal with a variety of concrete variables in situations where only limited standardization exists
Ability to interpret a variety of instructions furnished in written, oral, diagram, or schedule form
Knowledge of database software, internet software, and Microsoft word processing software
RN license in state(s) where cases are to be managed
Valid driver�s license
Valid automobile liability insurance
Ability to organize and evaluate workload and prioritize projects
Ability to meet deadlines
Ability to complete multiple, simultaneous projects with accuracy and efficiency
Detail orientation
Contract-level acceptance by Paradigm of the Case Manager to manage their cases

Responsibilities

Processes the case utilizing client's outcome management model and tools
Obtains written authorization for case management services as well as release of information
Assesses the client/family to identify their strengths and resources; problems; psychosocial, financial, and medical history; current status; diagnosis; prognosis; functional status; goals; current treatment plan; and needs
Develops a plan of care with client�s model through interdisciplinary collab-oration, which identifies realistic short- and long-term goals
Identifies, secures, and coordinates the services and resources to implement the plan
Monitors services being provided for continued appropriateness and reports to client and carrier
Evaluates the client�s progress, the plan, and the appropriateness of the services provided, with modifications as necessary
Provides ongoing instruction to the client and family regarding the injury/dis-ease process, treatment options, and present care
Promotes the client�s/family�s self-advocacy skills to achieve maximum self-sufficiency
Has knowledge of the benefit package as well as all available funding sources and systems of care and coordinates with the payer for authorization of payment
Provides for in-depth reporting of outcomes encompassing clinical, functional, financial, and customer satisfaction areas
Demonstrates effective, accurate, and timely verbal and written communication in all work situations
Identifies and discloses all situations which might result in exposure to legal liability and/or are indicative of poor-quality care negatively affecting the client
Frequently requires travel to patient appointments.
Performs other related duties as assigned in accordance with the necessary job function