Clinical Care Manager

Health Plan of San Mateo • CA

96d

About The Position

The Clinical Care Manager will perform comprehensive assessments, develop individualized care planning, initiate, and coordinate interdisciplinary case conferences with providers of service, support members in creating and adhering to person-centered care plans. Additionally, the Clinical Case Manager will be coordinating services with other departments, providers, programs, and community partners, as needed, to provide support.

Requirements

• Bachelor’s or associate degree.
• Two (2) years clinical experience.
• Three (3) years of managed care experience preferably in Care Coordination.
• Experience working with the health needs of the population served.
• At least one year of direct Care Coordination experience.
• Valid California license as a RN, LCSW, LMFT. PHN preferred. Will consider unlicensed master’s Level Social Worker (MSW/ASW).
• Certification as Certified Case Manager (CCM) preferred.
• Proficiency in Microsoft Office Suite applications, including Outlook, Word, Excel, Access, and PowerPoint.
• Strong knowledge of Medicare and Medi-Cal programs and benefits.
• Advanced knowledge of community resources.
• Understanding and familiarity of care transitions and discharge planning.
• Knowledge of HIPAA and other applicable federal and state regulations for confidentiality.

Nice To Haves

• Bilingual skills highly preferred, particularly Spanish, Tagalog or Chinese.

Responsibilities

• Manage a panel of assigned members to guide along the continuum of care to the optimal functional level and quality of life.
• Conduct comprehensive assessments and annual or as needed re-assessments of the member’s psychosocial, physical health, functional abilities, and social determinants of health.
• Develop an individualized care plan based on assessment information that is member-centered, comprehensive and consistent with program guidelines and policies and procedures.
• Identify member’s need for LTSS programs, Behavioral Health Services, community supports and other services to fill gaps in care, monitor effectiveness of services.
• Conduct outreach to member for care plan review, needs assessment and acuity monitoring.
• Establish and maintain open and effective communication with physicians and other health care and social service workers.
• Maintain necessary and complete documentation for all case management activities in the plan’s case management system, MedHOK.
• Lead and/or participate in clinical huddles and interdisciplinary care team meetings with internal HPSM staff and external partners and providers.
• Make referrals to various HPSM departments, community-based organizations, and governmental agencies when health and/or psychosocial condition(s) indicate need for appropriate referrals(s).
• Promote clear communication amongst the care team, which can include family and community supports, and treating providers by ensuring awareness regarding member care plans, and when supporting care transitions.
• Teach appropriate interventions, link to resources, educate about benefits, and discuss medication effects and side effects to patient, caregiver, volunteers, and others as appropriate.
• Adhere to case management practice standards at all times.
• Participate in continuous quality improvement efforts.
• Maintain knowledge of HPSM benefits, programs, and processes, in order to provide clear information to member and providers.
• Maintain knowledge of community resources and programs.
• Maintain working knowledge of confidentiality practices and standards.

What This Job Offers

• Education Level: Bachelor's degree
• Number of Employees: 101-250 employees