RN Care Manager

Community Health Plan of Imperial Valley•Imperial, CA

6d•$85,000 - $125,000

About The Position

Community Health Plan of Imperial Valley (CHPIV), Imperial County’s Medi-Cal managed care plan, is seeking a Care Manager to lead a team of Care Coordinators. The team supports members through case management, health management, and transition-of-care activities. The role provides direction and guidance to the care coordination team, manages caseloads based on the complexity of members’ medical or psychosocial needs, and helps ensure services align with the model of care and regulatory requirements. The Care Manager maintains compliant electronic case-management documentation, supports multidisciplinary collaboration and provider outreach, audits assessments and care plans, and monitors transition-of-care assessments and required contact timeframes. The role also participates in internal and external audits, prepares business requirements and training materials, and assists with coordinating appropriate member resources and services. The position is based in California. Candidates local to Imperial, California, are preferred; remote candidates living in California will also be considered.

Requirements

Active, unrestricted California Registered Nurse license.
At least 3 years of experience leading Care Coordinators.
At least 3 years in management, case management, disease management, or managed care in medical or behavioral health settings.
Knowledge of managed-care principles and practices, particularly Care Management and/or Care Coordination.
Clinical knowledge and critical-thinking skills to assess individualized whole-person care needs and develop effective care plans.
Working knowledge of and ability to efficiently use applicable computer software, including Outlook, Word, Excel, and specific case-management programs.
Experience partnering with multiple members of a healthcare team, internally and externally.

Nice To Haves

Local to Imperial, California.

Responsibilities

Provide direction and guidance to Care Coordinators to ensure activities align with the model of care and meet regulatory requirements.
Manage team caseloads appropriately according to the complexity of members’ medical or psychosocial needs.
Maintain the electronic case-management documentation system in compliance with standard processes, documentation styles, and HIPAA.
Complete required training and implement changes.
Promote multidisciplinary collaboration, provider outreach, and engagement of family members and caregivers to support continuity of care.
Audit case-management assessments and care-plan development for completeness and timeliness according to state requirements.
Monitor completion of Transition of Care assessments and ensure member contact occurs within applicable protocol timeframes.
Participate in required internal and external audits, which may be remote or onsite.
Create business requirements documents, user-training materials, and related documentation.
Assist with coordinating appropriate resources and services for members.