All Care To You

Supporting a collaborative work environment rooted in knowledge, trust, growth and respect.

Outpatient Case Manager

ManagerManagerFull TimeRemoteTeam 51-200Since 2018H1B No SponsorCompany SiteLinkedIn

Location

California

Posted

50 days ago

Salary

$70K - $95K / year

Associate Degree5 yrs expEnglish

Job Description

• Coordinate and oversee the care of patients receiving outpatient medical services. • 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. • 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 and team meetings. • Manage the cases to include case management and transition of care activities.

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

Benefits

  • 100% employer paid medical, vision, dental, and life coverage for employees.
  • Additional employee paid coverage options available.
  • Paid holidays.
  • Birthday off.
  • Unlimited PTO.
  • 401k plan.

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