Medical Case Manager; RN, Bilingual Spanish, English

Kinetic Personnel Group is currently recruiting a Medical Case Manager (RN) for a $3 billion-dollar a year government public health plan (government agency) is renowned for its work in the community and being a great place to work.

This position will be a six month temporary position with the possibility of going permanent for the right candidate. If the position goes permanent remote/telecommute options are available along with great government benefits (public health plan).

• Care Management
• Assesses member needs using a standardized health needs assessment or health risk assessment.
• Performs comprehensive, disease specific, clinical assessments of all identified cases, which includes but is not limited to, assessment of:
• Member’s physical, functional, social and psychological status
• Member’s cultural and linguistic needs
• Caregiver resources and available benefits
• Performs post-discharge assessments to identify member’s post-hospital or post-emergency department discharge needs including but not limited to:
• Member’s physical, functional, social and psychological status
• Member’s cultural and linguistic needs
• Caregiver resources and available benefits
• Follow-up provider care and ensuring scheduled appointments
• Durable medical equipment and supplies
• Community resources
• Develops and implements a member’s specific care plan which includes prioritized Specific, Measurable, Achievable, Relevant, and Time-Bound (SMART) goals.
• Reviews, modifies and updates care plans continuously to reflect the member’s needs, at minimum, annually or upon change in condition.
• Schedules follow-ups to assess progress towards goals and identifies barriers to meeting goals.
• Provides regular outreach to assigned members along with members from a worklist and evaluates quality of service given to members according to department contact standards.
• Coordinates care and services with members, members’ family members/representatives and other providers, as appropriate, including community supports and Long-Term Services and Supports (LTSS).
• Communicates with member’s physicians, specialists, community agencies and vendors to ensure coordination of services.
• Facilitates referrals to behavioral health/substance use disorder services and identifies and makes referrals to LTSS department, community supports and community resources.
• Facilitates and participates in Interdisciplinary Team meetings as applicable.
• Collaborates with interdepartmental staff in case resolution as needed.
• Identifies cases needing supervisor, manager, director or medical director review or input, routes accordingly and closes cases according to procedures and guidelines in a timely manner.
• Advocates in the member’s best interest for necessary funding, treatment alternatives, timelines and coordination of care and frequent evaluations of progress and goals.

• Associates degree in Nursing (ADN); or equivalent work experience required. Bachelor’s degree in Nursing (BSN) preferred.
• Current, unrestricted Registered Nurse (RN) license to practice in the State of California required.
• 3 years of clinical experience with the health needs of the population served required.
• An equivalent combination of education and experience sufficient to successfully perform the essential duties of the position such as those listed above is also qualifying.
• Bilingual in English and Spanish,
• An active Commission for Case Manager (CCM) certification preferred.
• Guidelines and regulations relevant to case management and utilization management.
• Understand confidentiality and the legal and ethical issues pertaining to case management.