Case Manager, PPO - 26-126

PriMed Management Consulting Services, Inc.; Sacramento (CA); Presencial; USD 100 000 - 123 000; Tempo integral

Resumo da oferta

PriMed Management Consulting Services, Inc., on behalf of Hill Physicians Medical Group, is seeking a Registered Nurse with case management experience in Northern California. You will support PPO members, assess needs, coordinate care, and document in Epic to ensure quality and cost-effective outcomes.

The role is full-time and on-site in California, requiring an active RN license and experience in managed care.

Qualificações

• Minimum three years clinical nursing experience in relevant care areas.
• Two years in case management or related managed care settings.
• California RN license; case management certification preferred.

Responsabilidades

• Collaborate with health plans to maximize at-risk member quality and cost management.
• Assess physical and psychosocial needs and develop a care plan.
• Coordinate care and document in Epic; maintain privacy and comply with standards.
• Coordinate internal/external resources and update care plans as needed.
• Attend in-service programs and perform other duties as assigned.

Conhecimentos

Clinical nursing

Case management

Communication skills

Independent work

Time management

ICD-9/CPT knowledge

Formação académica

A.S. degree

California RN licensure

Case management certification preferred

Ferramentas

Epic

Personal computers

Descrição da oferta de emprego

We’re delighted you’re considering joining us! At Hill Physicians Medical Group, we’re shaping the healthcare of the future: actively managed care that prevents disease, supports those with chronic conditions and anticipates the needs of our members. Join Our Team! Hill Physicians has much to offer prospective employees. We’re regularly recognized as one of the “Best Places to Work in the Bay Area” and have been recognized as one of the “Healthiest Places to Work in the Bay Area.” When you join our team, you’re making a great choice for your professional career and your personal satisfaction.

DE&I Statement:

At PriMed, your uniqueness is valued, celebrated, encouraged, supported, and embraced. Whatever your relationship with Hill Physicians, we welcome ALL that you are. We value and respect your race, ethnicity, gender identity, sexual orientation, age, religion, disabilities, experiences, perspectives, and other attributes. Our celebration of diversity and foundation of inclusion allows us to leverage our differences and capitalize on our similarities to better serve our communities. We do it because it's right!

Job Description:

Responsible for carrying out case management activities for PPO members identified through data or by Health Plan and referred to HPMG. 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 resource management and promotes quality and cost-effective interventions and outcomes. Case management activities are based on nationally recognized case management standards and concepts and principles. All contacts are telephonic.

Job Responsibilities:

• Collaborate with Health Plans care and disease management programs to maximize the at-risk population member’s quality and manage their costs.
• Assess members’ physical and psychosocial needs/barriers and develop a care plan.
• Support and encourage the use of participating Health Plan providers.
• Develop and implement the interventions needed to resolve barriers and coordinate care, allowing members to accomplish their goals with physician guidance and supervision.
• Document in Epic; assessments, care plans, interventions, and all other activity related to coordinating the care of case-managed members.
• Additional Responsibilities Maintain client privacy, safety, confidentiality, and advocacy while adhering to ethical, legal, regulatory and accreditation standards.
• Maintain department procedure/policy standards with regard to turnaround time, etc.
• Support the interdisciplinary team approach to ensure effective resource utilization, as well as quality and cost-effective outcomes.
• Coordinate internal and external resources for the individual member.
• Maintain and update a community resource database.
• Document all case management activities in the HPMG case management online system.
• Issue letters of explanation in accordance with department policy.
• Attend and participate in in-service programs and conferences that support practice of case management.
• Perform other duties as assigned.

Required Experience:

• Minimum three years clinical nursing experience in an area such as medical/surgical, critical care, home health or skilled nursing, and;
• Two years of experience in case management, behavioral health, utilization management, discharge planning, and or quality improvement in a managed care setting.
• Experience with managed care delivery including IPA networks and Medicare.
• PPO experience preferred.
• 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.

Required Education:

• A.S. degree
• Unrestricted California Registered Nurse licensure; certification in case management preferred.

Additional Information:

Salary: $100,100 - $123,000 Annual Hill Physicians is an Equal Opportunity Employer

PriMed Management Consulting Services, Inc., is the management services organization for Hill Physicians Medical Group, the largest Independent Physician Association (IPA) in Northern California. More than just a job - We’re making a meaningful contribution to healthcare. Everyone at PriMed contributes to making quality healthcare accessible for Northern Californians. We have a unique collection of skilled professionals that work well together and have been recognized as one of the top places to work and one of the healthiest places to work in the Bay area.