Job Summary The RN Case Manager oversees comprehensive care coordination for diverse patient cases, utilizing effective communication strategies and cultural sensitivity to engage members and providers. With a focus on chronic conditions, mental health, and homelessness, they assess, develop, and implement care plans while ensuring regulatory compliance and compassionate patient support.
Supervisory Responsibilities
Supervise the care management staff, including assisting in the development, training, network development, and assignment of work/projects.
Supervise and evaluate appropriateness of care coordination and direct the case management staff to modify plans as needed.
Duties & Responsibilities Utilize medical interventions to enhance members' self-management of health.
Engage with ECM Lead Care Managers via phone or in-person for assessment and care plan development.
Provide training for ECM Team Members on medical conditions and treatments.
Coordinate with internal and external partners to support members' comprehensive care.
Coordinate clinical care for ECM Program clients and establish care plan goals.
Organize and monitor services needed by recipients.
Perform bio-psycho-social assessments and develop care plans.
Oversee care plan implementation and monitor treatment adherence.
Provide coaching for behavior change and health improvement.
Document interactions and interventions accurately.
Collaborate with executives and assist in staff training for safety and quality assurance.
Design and execute training programs for Lead Care Managers.
Prepare formal responses and reports for regulatory agencies.
Establish effective processes and ensure compliance with regulations.
Assist in maintaining operational efficiency and quality care for patients.
Perform other duties as assigned.
Education and Experience Registered Nurse with a valid CA license from an accredited nursing school.
Associate degree in Nursing from an accredited institution required.
Bachelor's degree in nursing from an accredited institution preferred. Experience in a Health Care Organization or managed care setting preferred.
1-2 years of case management experience with low-income populations, focusing on complex chronic conditions, mental illness, and homelessness.
2 years of experience with homeless, low-income, and mentally ill populations, including substance abuse.
Experience in Medicare and Medi-Cal environments preferred.
Required Skills/Abilities Proficient in evidence-based communication techniques like Motivational Interviewing.
Bilingual in Spanish & English Required Understanding and sensitivity to multicultural communities.
Knowledgeable in self-management practices for chronic conditions.
Skilled in phone-based engagement with members and providers.
Proficiency in data interpretation and learning new software systems.
Strong attention to detail, analytical thinking, and interpersonal skills.
Ability to work autonomously and as part of a team.
Exceptional organizational and time management abilities.
Compassionate and empathetic approach to patient care.
Ability to analyze situations and act ethically and in compliance with regulations.
Flexibility to adapt to changing environments.
Physical Requirements Willingness to travel to different locations.
Prolonged periods sitting at a desk and working on a computer.
Must be able to lift up to 10 pounds at times.
Pay Range $90,000 - $100,000 USD
Benefits Our full-time employees are eligible for the following benefits enrollment after 60 days of employment:
Medical, Dental, & Vision Benefits
Short & Long-Term Disability Benefits
Voluntary Accident, Critical Illness, and Hospital Indemnity Plans
Flexible Spending Accounts
Employee Assistance Program (EAP)
401(k) Effective after 1 year of employment
Paid Vacation And Sick Leave
Paid Holidays
Employee Referral Program
Company Discount Program
Equal Employment Opportunity Optima Medical Management Group and its divisions are an Equal Opportunity Employer. Optima MMG is committed to providing employment opportunities for all qualified candidates without discrimination on the basis of race, religion, sex, sexual orientation, gender identity, age, national origin, citizenship, disability, marital status, veteran status, or any other characteristic protected by federal, state or local laws. Optima MMG is committed to providing reasonable accommodation for individuals with disabilities.
Pre-Employment Optima Medical Management Group is a drug-free workplace. Employment is contingent upon a successful pre-employment drug screening and background check.
Seniority Level Mid-Senior level
Employment Type Full-time
Job Function Health Care Provider
Industries Hospitals and Health Care
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