All Care To You
Supporting a collaborative work environment rooted in knowledge, trust, growth and respect.
Outpatient Case Manager
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.
Related Guides
Related Categories
Related Job Pages
More Manager Jobs
Case Manager, Registered Nurse – Commercial Plans
CVS HealthBringing our heart to every moment of your health.
Manager50 days ago
Full TimeRemoteTeam 10,001+Since 1963H1B No Sponsor
RN Case Manager conducting assessments and developing care plans for CVS Health
Asset Manager – Renewable Energy
Blue Sky Utility - Powered by Nofar EnergyFulfilling the potential of solar C&I.
Manager50 days ago
Full TimeRemoteTeam 11-50H1B No Sponsor
Renewable Asset Manager overseeing renewable energy asset management
Manager50 days ago
Full TimeRemoteTeam 10,001+Since 1988H1B Sponsor
District Manager leading reimbursement field team at Regeneron in Northeast region
New Jersey + 3 moreAll locations: New Jersey, New York, Pennsylvania, Washington
$200.7K - $241.9K / year
Manager50 days ago
Full TimeRemoteTeam 1,001-5,000Since 1993H1B No Sponsor
Nurse Care Manager enhancing health outcomes for high-risk patients at HarmonyCares