Medical Case Manager (RN, Bilingual Spanish, English)

Kinetic Personnel Group, Inc; Orange (CA); Hybrid; USD 70,000 - 90,000; Full time

Benefits offered by this job

Government benefits

Potential remote work options

Job summary

A prominent healthcare recruitment firm is seeking a Medical Case Manager (RN) in California. This role involves conducting comprehensive health assessments and developing tailored care plans for members. With a focus on improving health outcomes, the position requires an RN license in California and 3 years of clinical experience. Bilingual candidates in English and Spanish are preferred. The job could lead to a permanent placement, offering potential remote options and government benefits.

Qualifications

• Current, unrestricted Registered Nurse (RN) license to practice in California.
• 3 years of clinical experience with the health needs of the population served.

Responsibilities

• Conduct care management and health needs assessments for members.
• Develop and implement care plans with SMART goals.
• Coordinate services with various stakeholders for optimal member care.

Skills

Bilingual in English and Spanish

Clinical experience

Advocacy for patient care

Care management

Education

Associates degree in Nursing (ADN)

Bachelor’s degree in Nursing (BSN)

CCM certification

Job description

Kinetic Personnel Group is currently recruiting a Medical Case Manager (RN) for a $3 billion-dollar a year government public health plan (government agency) is renowned for its work in the community and being a great place to work.

This position will be a six month temporary position with the possibility of going permanent for the right candidate. If the position goes permanent remote/telecommute options are available along with great government benefits (public health plan).

Position Responsibilities

• Care Management
• Assesses member needs using a standardized health needs assessment or health risk assessment.
• Performs comprehensive, disease specific, clinical assessments of all identified cases, which includes but is not limited to, assessment of:
• Member’s physical, functional, social and psychological status
• Member’s cultural and linguistic needs
• Caregiver resources and available benefits
• Performs post-discharge assessments to identify member’s post-hospital or post-emergency department discharge needs including but not limited to:
• Member’s physical, functional, social and psychological status
• Member’s cultural and linguistic needs
• Caregiver resources and available benefits
• Follow-up provider care and ensuring scheduled appointments
• Durable medical equipment and supplies
• Community resources
• Develops and implements a member’s specific care plan which includes prioritized Specific, Measurable, Achievable, Relevant, and Time-Bound (SMART) goals.
• Reviews, modifies and updates care plans continuously to reflect the member’s needs, at minimum, annually or upon change in condition.
• Schedules follow-ups to assess progress towards goals and identifies barriers to meeting goals.
• Provides regular outreach to assigned members along with members from a worklist and evaluates quality of service given to members according to department contact standards.
• Coordinates care and services with members, members’ family members/representatives and other providers, as appropriate, including community supports and Long-Term Services and Supports (LTSS).
• Communicates with member’s physicians, specialists, community agencies and vendors to ensure coordination of services.
• Facilitates referrals to behavioral health/substance use disorder services and identifies and makes referrals to LTSS department, community supports and community resources.
• Facilitates and participates in Interdisciplinary Team meetings as applicable.
• Collaborates with interdepartmental staff in case resolution as needed.
• Identifies cases needing supervisor, manager, director or medical director review or input, routes accordingly and closes cases according to procedures and guidelines in a timely manner.
• Advocates in the member’s best interest for necessary funding, treatment alternatives, timelines and coordination of care and frequent evaluations of progress and goals.

Requirements

• Associates degree in Nursing (ADN); or equivalent work experience required. Bachelor’s degree in Nursing (BSN) preferred.
• Current, unrestricted Registered Nurse (RN) license to practice in the State of California required.
• 3 years of clinical experience with the health needs of the population served required.
• An equivalent combination of education and experience sufficient to successfully perform the essential duties of the position such as those listed above is also qualifying.
• Bilingual in English and Spanish,
• An active Commission for Case Manager (CCM) certification preferred.
• Guidelines and regulations relevant to case management and utilization management.
• Understand confidentiality and the legal and ethical issues pertaining to case management.