Case Manager RN/LVN

Health Center Partners; San Diego (CA); Remote; USD 84,000 - 106,000; Full time

Job summary

An established industry player is seeking a dedicated care coordinator to enhance patient experiences and improve health outcomes. This role involves developing personalized care plans, engaging with patients, and ensuring effective communication among caregivers and providers. The ideal candidate will have a strong clinical background, excellent interpersonal skills, and a commitment to promoting wellness in the community. Join a forward-thinking organization that values high-quality, coordinated care for its diverse patient population, and be part of a team that makes a real difference in people's lives.

Qualifications

• RN or LVN license required for this role.
• 2-3 years of clinical experience needed; knowledge of Medicare preferred.

Responsibilities

• Develop personalized care plans and engage patients effectively.
• Monitor hospital admissions and coordinate care among providers.

Skills

Patient Care Management

Communication Skills

Care Coordination

Knowledge of Medicare

Interpersonal Skills

Education

RN or LVN License

CCMC Certification

2-3 Years Clinical Experience

Tools

EMR Systems (Arcadia)

Job description

Health Center Partners provided pay range

This range is provided by Health Center Partners. Your actual pay will be based on your skills and experience — talk with your recruiter to learn more.

Base pay range

$84,000.00/yr - $106,000.00/yr

COMPANY:My Choice Quality Care Network

REPORTS TO:Director of Clinical Strategy

STATUS:Exempt / FULL TIME

WORK COMP CLASS:8810

OUTSIDE TRAVEL: 25% (Candidate must live in San Diego or the surrounding area)

WORK CONDITIONS:Remote / Home Office

WORK SCHEDULE:7-7/M-F

This job description is intended to be a general statement about this job and is not to be considered a detailed assignment. It may be modified at any time, with or without advance notice, to meet the needs of the organization.

Job Summary

My Choice Quality Care Network (MCQCN) is a newly formed FLEX Model Accountable Care Organization (ACO), a subsidiary of Integrated Health Partners of Southern California, managing over 350,000 Medi-Cal (Medicaid) lives. The ACO focuses on providing high-value, accessible, coordinated clinical and social care to the aging population. The clinical care team plays a critical role in supporting Medicare beneficiaries' clinical, behavioral, social, and support needs. This position, supervised by the Director of Clinical Strategy, is responsible for facilitating and coordinating care management services within the ACO population, including care planning, coordination, and facilitation activities that promote high-quality, cost-effective access to care.

The role involves assessing patient needs, developing actionable care plans, and working closely with patients and health centers to ensure effective implementation, aiming for positive health outcomes and experiences.

Essential Job Functions

Case Management

1. Patient/Caregiver Experience

• Develop personalized, whole-person care plans addressing services and resources needed to improve health.
• Engage patients and communicate active care plans, informing clinicians of non-compliance for updates.
• Implement strategies to enhance patient satisfaction.
• Facilitate communication among patients, caregivers, and providers for a positive experience.
• Address concerns promptly to improve patient experience.
• Educate about available resources and support services.

Care Coordination/Patient Safety

• Monitor hospital admissions/readmissions to identify patterns and reduce avoidable cases.
• Use EMRs like Arcadia to track information and ensure smooth care transitions.
• Coordinate among providers to ensure continuity and safety.
• Implement patient safety protocols to minimize risks.
• Review and update care plans regularly.

Preventive Health

• Promote wellness screenings and educate patients on preventive measures.
• Track quality metrics and develop clinical action plans for improvements.

Clinical Care for At-Risk Populations

• Manage care for patients with chronic conditions, developing personalized plans.
• Monitor and adjust care plans as needed.
• Coordinate with specialists for comprehensive care.
• Educate and support patients in managing health conditions.

Coding & Documentation Integrity

• Provide guidance on HCC coding and documentation audits.
• Review documentation to support clinical and social health needs.

Other duties include developing team tools, building community relationships, participating in meetings, and other responsibilities as assigned.

Qualifications

Education and Experience

• RN or LVN license required.
• CCMC or equivalent certification preferred.
• 2-3 years clinical experience required; 3+ preferred.
• Knowledge of regional health disparities and social determinants of health.
• Understanding of Medicare and Medicare Advantage preferred.
• Strong interpersonal and communication skills.
• Proficiency with relevant computer systems.

Other Skills/Abilities

Physical requirements include sitting/standing for long periods, reaching, bending, lifting up to 20 lbs., and working in an office setting. Must handle high stress and meet deadlines.

HIPAA/Compliance

• Maintain confidentiality and comply with security and privacy regulations.
• Attend annual HIPAA training and sign necessary agreements.

We are an equal opportunity employer. The pay range for California residents is $84,000-$106,000, with actual offers based on skills, experience, and location. We typically offer salaries near, at, or below the range midpoint to promote fairness.