Nurse Case Manager I

Partnership HealthPlan of California • Fairfield, CA

80d • $49 - $64

About The Position

To initiate and coordinate a multidisciplinary team approach to case management. Engages the member/member’s representative in a care plan that assists the member in meeting his/her health and wellness goals. Collaborates, assesses, plans, facilitates, evaluates, and advocates to meet the comprehensive medical, behavioral, and psychosocial needs of the member, while promoting quality and cost-effective outcomes.

Requirements

• Associate’s degree in Nursing required; Bachelor’s degree in Nursing (or higher) preferred.
• 2 years of experience preferred, to include at least one (1) year of case management experience and one (1) year in an acute care setting; or equivalent combination of education and experience.
• General knowledge of managed care and/or experience with Medicaid population preferred.
• Current and unrestricted California Registered Nurse License.
• Valid California driver’s license and proof of current automobile insurance compliant with PHC policy are required to operate a vehicle and travel for company business.
• Bilingual skills in Spanish, Russian, or Tagalog preferred.

Responsibilities

• Provides case management services independently for a caseload ranging in complexity from basic to complex; acuity levels 1-4; performs field-based case management (acuity level 5) with supervision.
• Initiates and coordinates individualized care plan for assigned members, addressing both clinical and non-clinical components, and ensuring the care plan is available to both the member and primary care provider.
• Resolves member needs by utilizing multidisciplinary team strategies, including Health Services Integrated Rounds Meetings.
• Ensures a smooth implementation and continuum of care via effective and frequent communication with providers, members, and identified health care designee.
• Communicates clearly and effectively through all mediums of communication with members, providers, vendors, community partners, and PHC employees.
• Coordinates referrals and authorizations for services required to improve the member’s health status.
• Maintains accurate and timely documentation, records, and case files in the PHC Case Management System for members in case management.
• Applies evidence-based interventions based upon member’s agreed upon goals/priorities.
• Develops and maintains knowledge of a community based network of alternative modes of care; aids member to connect with community-based organizations to support and enhance wellness.
• Answers and triages department calls, and distributes department referrals with guidance, in accordance with identified department service levels.
• Collaborates and coordinates with other internal departments to identify members suitable for case management.
• Actively participates in essential skills training, unit and departmental assigned learning, and other departmental activities as assigned.
• Functions collaboratively in a team environment, including acting as a support and resource to other staff.
• Coordinates and participates in meetings with PHC providers, as assigned.
• Collaborates with other departments with coordination of care needs through the course of case management services.
• Demonstrates competence in NCQA documentation standards.
• Exhibits high professional standards as outlined in the CA Nurse Practice Act and PHC’s Code of Conduct.
• Performs other duties as assigned by the direct supervisor, including the assumption of new duties.

Benefits

• Strong organizational, communication, critical thinking skills and attention to detail required.
• Ability to work within an interdisciplinary structure and function independently in a fast-paced environment while managing multiple priorities and meeting deadlines.
• Effective telephone and computer data entry skills required.
• Experience in managed care business practices and ability to access data information using various computer systems.
• Excellent English written and verbal communication skills required.

What This Job Offers

• Education Level: Associate degree