Nurse Case Manager (Care Coordination Case Manager), South San Francisco, CA
CARE COORDINATION CASE MANAGER
The Health Plan of San Mateo (HPSM), a managed care health plan, seeks a full time Care Coordination Case Manager to perform comprehensive assessments, develop individualized care planning, initiate and coordinate case conferences with providers of service, make determinations regarding appropriateness of service and determine medical necessity of services requiring prior authorization. The essential duties & responsibilities will include the following:
- Identify the Member’s and family’s physical, psychosocial, environmental, safety and developmental needs and individualize the member’s plan of care based on the needs identified.
- Communicate with member and/or family/responsible party to initiate and develop individualized care plans.
- Contact identified high risk members and member families to establish plan of care with understanding of goals as developed with primary care provider; provide clinical and liaison services, including follow-up of discharge from ER and acute/skilled inpatient admissions.
- Assist members with appointments for specialists, educational classes, and transportation.
- Contact healthcare provider to establish medical record, plan treatment and develop documentation of care plan.
- Make referrals to various HPSM departments, community based organizations and governmental agencies when health and/or psychosocial condition(s) indicate need for appropriate referral(s).
- Promotes clear communication amongst the care team and treating providers by ensuring awareness regarding member care plans.
- Teach appropriate interventions, link to resources, educate about benefits, and discuss medications effects and side effects to patient, caregiver, volunteers and other as appropriate.
- Participate in continuous quality improvement efforts
- Perform other duties as assigned.
License: Valid California license as a Registered Nurse or LVN. PHN preferred.
Certification: Certification as Certified Case Manager (CCM) preferred.
Education and Experience: Bachelor or Associates degree in nursing. Two (2) years clinical nursing experience. Knowledge of: Case management principles and practices. Medicare and Medi-Cal programs and benefits. Community resources. The complexities of working with the elderly and disabled populations. Personal computers and proficiency in Microsoft Office Suite applications, including Outlook, Word, Excel, Access, and PowerPoint.
Ability to: Work efficiently with people in varying positions. Gain consensus on resolution of problems. Work independently, with limited supervision; problem solve independently. Provide excellent customer service. Effectively communicate both verbally and in writing. Utilize personal computers and Microsoft Office products (Word, Excel, Access and Outlook).
Other Requirement: Bilingual skills (Spanish, Tagalog, Russian or Chinese) highly preferred.
Starting Compensation Range: Between $40.86/hour - $51.82/hour – depending on experience.
Benefits Information: Excellent benefits package offered, including HPSM paid premiums for employee’s coverage in the medical HMO plan and majority of PPO medical cost. Employee pays a small portion of the dependent premiums for medical and dental benefits. Additional HPSM benefits include fully paid vision, life, AD&D, STD, and LTD insurance; retirement plan (10% of salary for compensation/HPSM paid); holiday and vacation pay; tuition reimbursement plan; and more.
Application Process: To apply, submit a resume and cover letter with salary expectations to: Health Plan of San Mateo, Human Resources Department, 801 Gateway Blvd., Suite 100, South San Francisco, CA 94080 or via email: firstname.lastname@example.org or via fax: (650) 616-8039. File by: Continuous until filled. EOE