PHM Case Manager RN I

Kern Family Health Care•Bakersfield, CA

About The Position

Kern Family Health Care (KFHC) is dedicated to improving members’ health through an integrated managed health care delivery system. Under the direction of the KFHC PHM Case Management Supervisor RN, the PHM Case Manager RN I provides complex case management to diverse, high-risk Medicaid populations. The role coordinates care and services for members who need support navigating the healthcare system, helping ensure appropriate care and services are delivered at the right place and time. Services use resources across the continuum of care and are provided in collaboration with members, caregivers, medical home providers, and ancillary health care providers. KFHC uses a Population Health approach to identify groups and strengthen member engagement and care coordination to improve clinical outcomes. Incumbents are fully competent in the essential areas of basic and complex case management and are expected to exercise advanced judgment. Case Managers work independently under general direction and communicate frequently with members, caregivers, medical providers, and KFHC staff by telephone, electronically, and potentially in person.

Requirements

Active, current, unrestricted California Registered Nurse license.
Associate degree in Nursing required.
At least 2 years of full-time clinical experience in acute care, a community health setting, public health nursing, or chronic disease management.
Experience working with patients and caregivers regarding self-care and disease management.

Nice To Haves

Bachelor’s degree in Nursing.
Experience working in case management or care coordination.
Knowledge of Kern County community resources for seniors and people with disabilities.
Bilingual English/Spanish.

Responsibilities

Identify members at high risk for medical care resource utilization by reviewing referrals from Health Risk Assessments, physicians, other medical providers, or family, and assess needs as appropriate.
Conduct assessments to identify member needs and develop specific care plans addressing objectives, barriers, and goals.
Coordinate and manage care across the continuum, including outpatient care, medical home providers, and ancillary services.
Provide education and coordinate outpatient care for KFHC members selected for Case Management.
Identify and refer quality-of-care, coordination-of-benefits, and third-party-liability issues as appropriate.
Develop collaborative action plans with clearly identified, achievable objectives focused on modifiable risk factors.
Complete and document initial case management assessments according to departmental processes.
Participate in care management conferences and collaborate with team members and community providers.
Document care plan notes thoroughly and in a timely manner in accordance with professional standards and departmental processes.
Communicate, consult, and collaborate with the KFHC Medical Director as needed.
Serve as a liaison to community providers and KFHC members.
Communicate in writing and verbally with contract providers and KFHC staff to promote appropriate and timely care coordination.
Perform other related duties and special projects as assigned.