Nurse Case Manager Job in San Leandro 94577, California Us
Nurse Case Manager – CHCN
Company: Community Health Center Network
Department: Utilization Management
Reports to: UM/QI Manager
Date Prepared: August 24, 2011
Community Health Center Network (CHCN) is a nonprofit management services organization (MSO) in partnership with eight health service organizations in Alameda and Contra Costa County for Medi-Cal, Healthy Families, and Medicare Advantage programs, seeks a Complex High Risk Nurse Case Manager to identify and intervene in complex cases, perform welcome home calls, assessment of treatment, develop individualized care planning, initiate and coordinate case conferences with providers of service.
DESCRIPTION:
Coordinates the flow of clinical information between CHCN clinics, hospitals, emergency departments, specialists, pharmacies, and other providers of care for CHCN’s clinic patients. Proactively in a collaborative effort, identify and coordination short and/or long term needs of catastrophically/chronically ill persons and their families. Assist clinics with the development of case management strategies cross the continuum of care for care coordination and community resources.
· Work with clinicians at CHCN clinics to develop telephonic case management strategies for the purpose of improving patient care; help lead the case management advisory group with participation from clinic staff
· Participate in the development and maintenance of a case management system, using information available to CHCN (hospital, ER, pharmacy, etc.) This web enabled system will require working closely with both clinic and CHCN staff and assist with their training.
· Works directly with the Medical Director, COO, and UM Manager on clinical and operational issues to identify patient sub-groups whose care could be improved by case management interventions.
· Maintain a current library of patient resources for CHCN clinics.
Assist members with appointments for specialist, educational classes, and transportation.
· Assist with the review of urgent care claims and other designated operational duties.
· Work with member clinics on the implementation of specific projects that involve coordination of information among various providers (such as the “PHASE” program) on an as needed basis.
· Work with health plans on special requests such as obtaining ancillary services from non-contracting providers.
· Coordinate completion and send required Case Management monthly reports to Health Plans, as assigned.
· Support the UM nurse coordinator in the management of the daily in-patient census, including Skilled Nursing Facility (SNF) and rehab patients; coordinate care with hospitals/HMO’s as needed; assist with coordination of discharge planning, especially for complex in-patients.
· Provide back-up support to UM department.
· Other duties as assigned.
PREFERRED
· Minimum of two (2) years of Case Management experience required.
· Two (2) years in Utilization Management in hospital, HMO, or IPA setting preferable.
· Minimum of four (4) years in a health care delivery setting at hospital, clinic or physician’s office.
· Experience coordinating care across multiple sites.
ESSENTIAL REQUIREMENTS
· Active, unrestricted, California Nursing License, RN or LVN. LCSW or MSW with at least 4 years of medical experience would be acceptable.
· Certification as CCM (Certified Case Manager) or equivalent is preferred.
· Strong working knowledge of case management, Medicare, and Medi-Cal benefits.
· Strong understanding of the managed care environment.
· Some travel required; a valid California driver’s license and proof of current auto insurance.
SKILLS
· Competent leadership and administrative skills.
· Good communication and customer relations’ skills; ability to work well with a team.
· Utilization Management experience; understanding and knowledge of healthcare benefits associated with various business lines (Medi-Cal, Medicare, and Commercial).
· Experience working with complex medical patients, including the aged, blind, disabled.
· Ability to work independently in most instances, requiring limited supervision.
· Proficiency in computer operations and comfortable with Internet-based applications. Fundamental word processing and computer navigation skills.
· Sound decision-making skills including problem solving, critical thinking, and good clinical judgment for clinical and non-clinical issues.
· Logical, independent thinker.
· Professional demeanor.
CONDITIONS and BENFITS:
This is an opportunity to work for an innovative healthcare organization, offering an excellent competitive salary and benefits package. Hours of work are primarily limited to business hours (8 AM – 5 PM, Monday through Friday), although occasionally may require additional hours to meet timelines or to meet needs of systems being supported. The role is based out of Community Health Center Network offices located in San Leandro, CA.
TO APPLY:
Please send resume and cover letter with salary requirements to:
nursecasemgr1@chcnetwork.org (Principals only, please)
Please note that a background investigation is completed on candidates prior to hire.
The Community Health Center Network is an Equal Opportunity Employer.