PHM Case Manager RN I

KHS•Bakersfield, CA

4d•$40 - $51

About The Position

Under the direction of the Kern Family Health Care (KFHC) PHM Case Management Supervisor RN, the PHM Case Manager RN I provides complex case management to diverse groups of high-risk Medicaid populations. The role coordinates care and services for members who need assistance navigating the healthcare system, helping ensure they receive appropriate care and services at the right place and time. Services use available resources across the continuum of care and are delivered in collaboration with members, caregivers, medical home providers, and ancillary healthcare providers. KFHC uses a Population Health approach to identify diverse groups, enhance member engagement, and coordinate care across populations to improve clinical outcomes. Case Managers are fully competent in basic and complex case management, exercise advanced judgment, and work independently under general direction. The position involves frequent communication with members, caregivers, medical providers, and KFHC staff by telephone, electronically, and potentially in person. Work location is onsite or hybrid, and travel may be up to 10%.

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 outpatient care coordination to 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 promptly 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.
Provide written and verbal communication with contract providers and KFHC staff to promote appropriate and timely care coordination.
Perform other related duties and special projects as assigned.