Complex Case Manager
Complex Case Manager
Job Summary:
This position is responsible for carrying out case management activities for members referred to the case management program across all levels of care. Case management is a collaborative process that assesses, plans, implements, coordinates, monitors, and evaluates options and services required to meet the client’s health and human service needs. It is characterized by advocacy, communication and resources management and promotes quality and cost-effective interventions and outcomes. Case management activities are based on nationally recognized case management standards and the patient’s concepts and principles. Contacts are telephonic and/or onsite as needed.
Essential Functions:
- Advocate for member in order to assist in meeting healthcare needs
- Maintain member privacy, security and confidentiality
- Conduct in-home assessment visit or call
Required Education:
- Unrestricted California Registered Nurse licensure; certification in case management preferred
- Valid California Driver’s License
Qualifications:
- Experience with managed care delivery including IPA networks and Medicare
- Optimum organizational skills with ability to meet both expected and unexpected time frames
- Excellent verbal and written communication skills
- Ability to coordinate effectively with a variety of customers including members, providers, office staff, health plans, internal department, community resources, and peers
- Ability to work independently with self-initiative and discipline
- Knowledge of ICD-9 and/or CPT coding
- Working knowledge of personal computers
Desired Skills:
- Ca Minimum three years clinical nursing experience in an area such as medical surgical, critical care, home health or skilled nursing
- Two years of experience in case management, utilization management, discharge planning and or quality improvement in a managed care setting.