General Case Manager; RN or LVN

Case Manager (Talent Assistant) at Clinicas del Camino Real Inc

This range is provided by Clinicas del Camino Real, Inc.. Your actual pay will be based on your skills and experience — talk with your recruiter to learn more.

$81,000.00/yr - $96,500.00/yr

The Case Manager (CM) will work in office, and/or field settings supporting our Clinicas del Camino Real membership. Performs care management duties to assess, plan and coordinate aspects of medical and supporting services across the continuum of care for member identified to be medium rising risk or high utilizers. This position works with the care management and coordination teams to identify care medical and social needs and to establish support services to promote quality member outcomes.

• Assessment: involves a comprehensive collection of data and ongoing collaborative process of observation, information gathering, reflection and engagement with the client, and analysis of the client's overall situation and needs.
• Member Centered: actively participate in and are at the center of decision making and support planning. This fosters trust and ensures that the services provided align with the Members’ expectations and needs by Empowering them to take an active role.
• Planning: to establish specific objectives and care goals, both short- and long-term, based on the client's needs identified earlier in the assessment process.
• Effective Communication: extends to writing concise and accurate reports, documentation, and referrals and leveraging technology to facilitate collaboration. Members utilize effective listening to understand the Member’s needs, concerns, and feedback, ensuring that they feel heard and respected.

Care Team promotes seamless communication among all team members supported by regular meetings and shared data methodologies.

• Conduct Regular Evaluations: Regularly evaluate the case management processes to identify strengths and pinpoint areas for improvement. Such as encourage regular client check-ins and perform ongoing updates and activities resulting from CM arrangements such as PCP, Specialty and Community encounters.
• Advocacy
  
  Skills:
  
  As the case manager, to advocate on behalf of assigned CM members to ensure they receive the services and support to promote quality CM outcomes.

• Develop, guide and provide case management services by utilizing clinical expertise, and coordination efforts with the medical management team, community supports and contracted upstream health plan.
• Analyze medical trends and intervene with members identified to be at rising medium risk and/or high utilizers.
• Interact with members’ primary care physicians, and specialists to provide seamless case management activities across the care continuum.
• Interact with community/system resources, and maintain resource directories of collaborative and supporting agencies.
• Establish individualized member care plans that incorporate prioritized case goals, implementation plans, and ongoing measurement of outcomes.
• Access and utilize data from various data systems to create a comprehensive member case file that is supported with member assessments, clinical reports, encounters, community appointments, medication management, and identified SDOHs.
• Collaborate with healthcare professionals to assess, plan, and coordinate patient care needs.
• Participate in quality improvement activities to enhance clinical outcomes and resource utilization.
• Collect and analyze patient information for third-party vendors.
• Arrange or participate in member case conferences internally at CDCR, externally with GCHP and community agencies.
• Submit timely progress reports and updated member care plans and profiles as necessary to support continuum in the member’s case management process.
• Perform telephonic assessment to assess member needs and collaborate with resources and provides education/support for treatment regimen adherence and medication management to support self-management and independent living.
• Identify potential care gaps and make referrals as appropriate.
• Identify available community services and health resources and facilitate access to…