RN Care Manager

Community Health Plan of Imperial Valley; Oregon; Hybrid; USD 85,000 - 125,000; Full time

Benefits offered by this job

Health, dental, and vision insurance

Paid time off

401k plan with generous match

Chance to make a real difference in a等

Job summary

Community Health Plan of Imperial Valley (CHPIV) seeks an experienced RN leader to guide the care coordination team and ensure regulatory alignment.

You will manage caseloads, maintain electronic case management records in HIPAA-compliant systems, and promote collaboration with providers, family, and caregivers to improve continuity of care.

Remote or onsite options within California are considered; a competitive salary $85,000-$125,000 per year plus benefits.

Qualifications

• Active California RN license without restriction.
• Minimum 3+ years leading care coordinators.
• 3+ years in management, case management, or managed care in medical or behavioral health settings.
• Knowledge of managed care principles with emphasis on care management.
• Clinical knowledge to assess whole-person care needs for effective plans.
• Proficient in Outlook, Word, Excel and case management software.

Responsibilities

• Provide direction and guidance to the care coordination team to ensure implementation of activities that align with the model of care and meet regulatory requirements.
• Manage caseloads for the team appropriately with regard to complexity of medical or psychosocial needs.
• Maintain electronic case management documentation system in compliance with standard processes and HIPAA.
• Complete all training requirements and implement changes.
• Promote multidisciplinary collaboration, provider outreach, and engagement of family and caregivers to enhance continuity of care for members.
• Audit case management assessments and care plan development for completeness and timeliness according to state requirements.
• Monitor the completeness of the TOC assessment and timeframes for contact per TOC protocols.
• Participate in required internal and external audits both remote or onsite.
• Create business requirement documents, user training materials and other related documentation.
• Assist with care coordination for appropriate resources and services for members.

Skills

Care coordination leadership

Management experience

Clinical knowledge

Outlook/Word/Excel proficiency

Collaboration with healthcare teams

Education

California Registered Nurse License

Tools

Outlook

Word

Excel

Case management software

Job description

Community Health Plan of Imperial Valley (CHPIV) is Imperial County's Medi-Cal managed care plan. We are a locally managed public health care plan committed to working with members, providers, and the residents of Imperial County.

Our next team member will do the following:

• Provide direction and guidance to the care coordination team to ensure implementation of activities that align with the model of care and that meet all regulatory requirements
• Manage caseloads for the team appropriately with regard to complexity of medical or psychosocial needs (RN, LVN, LSW, other allied fields)
• Maintain electronic case management documentation system in compliance with standard processes, standard documentation styles, and HIPAA
• Complete all training requirements and implement changes
• Promote multidisciplinary collaboration, provider outreach, and engagement of family and caregivers to enhance the continuity of care for members
• Audit case management assessments and care plan development for completeness and timeliness according to state requirements
• Monitor the completeness of the Transition of Care (TOC) assessment and the timeframes for contact per TOC protocols
• Actively participates in required internal and external audits either remote or onsite
• Create business requirement documents, user training materials and other related documentation
• Assist with care coordination for appropriate resources and services for members

You may be right for this job if you have the following:

• An active California Registered Nurse License without restriction
• A minimum of 3 years leading Care Coordinators
• 3 or more years in management, case management, disease management, managed care in medical or behavioral health settings
• Knowledge of managed care principles and practices with emphasis in Care Management and/or Care Coordination
• Clinical knowledge and critical thinking skills with the ability to assess individualized whole-person care needs necessary to develop an effective care plan
• Working knowledge of and the ability to efficiently operate all applicable computer software including computer applications such as Outlook, Word, Excel, and specific case management programs
• Experience partnering with multiple members of a healthcare team both internally and externally

Our commitment to you:

• A competitive salary of $85,000-$125,000/ year
• Health, dental, and vision insurance
• Paid time off
• A 401k plan with a generous match
• A chance to make a real difference in the Imperial Valley community

Preference will be given to candidates who are local to Imperial, California, but remote candidates living in California will also be considered.

We are an equal-opportunity employer. We celebrate diversity and are committed to creating an inclusive environment for all employees.