Outpatient Case Manager

All Care To You • Orange, CA

9d • $70,000 - $120,000 • Remote

About The Position

As an Outpatient Case Manager, you will be responsible for coordinating and overseeing the care of patients receiving outpatient medical services. Case Management is a collaborative process that assesses, plans, implement, coordinates, monitors and evaluates options and services required to meet the client’s health and human needs. It is characterized by advocacy, communication and resource management and promotes quality and cost-effective interventions and outcomes. Case management activities are based on nationally recognized case management standards and concepts and principles. All contacts are telephonic.

Requirements

• Current CA & TX/Multi State LVN or RN licensure.
• CM and/or UM training and/or certification. Knowledge of CM standards, UM standards, Clinical Standards of Care, NCQA requirements, CMS guidelines, Milliman guidelines, and InterQual guidelines. Medi-Cal, Commercial and Medicare contracts and benefit interpretation is preferred.
• Five years+ clinical experience.
• Excellent communication, interpersonal, and problem-solving skills, with the ability to interact effectively with patients, families, and healthcare professionals.
• Ability to work independently and collaboratively in a fast-paced environment, prioritizing tasks and managing multiple responsibilities effectively.
• Commitment to patient-centered care, cultural competence, and ethical practice.
• Process oriented.
• Proficiency using Outlook, Microsoft Teams, Zoom, Microsoft Office (including Word and Excel) and Adobe
• Detail oriented and highly organized.
• Strong ability in problem-solving
• Ability to self-manage, strong time management skills.
• Ability to work in an extremely confidential environment.
• Strong written and verbal communication skills
• Valid CA and Texas/Multi State Registered Nurse license, Licensed Clinical Social Worker (LCSW), or equivalent.

Nice To Haves

• Prefer of two (2) years+ experience in an HMO/IPA/Managed care setting is preferred and recommended.

Responsibilities

• Identification of members appropriate for case management, based on identification of health-related problems.
• Assessing members physical and psychosocial needs/barrier.
• Developing the case management care plan.
• Developing and implementing the interventions needed to resolve barriers and coordinate care, allowing members to accomplish their goals with physician guidance and supervision.
• Documenting assessments, care plan interventions, and all other activities related to coordinating the care of the case managed members.
• Maintain client privacy, safety, confidentiality, and advocacy while adhering to ethical, legal, regulatory and accreditation standards.
• Maintain department procedure/policy standards with regards to turnaround time, etc.
• Support the interdisciplinary team approach to ensure effective resource utilization, as well as quality and cost-effective outcomes.
• Coordinate resources for members.
• Document all case management activities in the Ezcap system.
• Utilize reports and systems to identify and monitor utilization patterns and facilitate needed care coordination.
• Attend Interdisciplinary meetings.
• Attend team meetings.
• Manage the cases to include case management and transition of care activities.
• Understand the health plan and regulatory requirements as it relates to Care Management and transition of care.
• Ability to keep high level of confidence and discretion when dealing with sensitive matters relating to providers, and members.
• Always maintains strict confidentiality.
• Other duties as needed.

Benefits

• ACTY offers 100% employer paid medical, vision, dental, and life coverage for our employees.
• Additional employee paid coverage options available.
• We also offer paid holidays, birthday off, and unlimited PTO as well as a 401k plan.

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level
• Education Level: No Education Listed