Weekend Outpatient Case Manager & RN Reviewer

Imperial Health Plan; Pasadena (CA); On-site; USD 45,000 - 50,000; Full time

Job summary

Imperial Health Plan in Pasadena, CA is seeking an Outpatient Case Manager to oversee intake and provide case management for members with chronic conditions and socioeconomic/mental health comorbidities.

Under the supervision of the Case Management Program Manager, you will develop individualized care plans, coordinate with PCPs and the care team, ensure HIPAA compliance, and strive to improve health outcomes.

Qualifications

• Minimum of 2 years of nursing experience in an acute care hospital setting.
• Minimum of 1 year of managed care and utilization review experience.
• Experience with CMS and MCG guidelines.
• Experience with clinical review.
• Clinical knowledge of chronic conditions, such as diabetes and congestive heart failure.
• Strong written and verbal communication skills with patients, physicians, and other stakeholders.
• Demonstrated ability to assess and respond to patient and family needs in a timely manner.
• General knowledge of case management practices, including familiarity with relevant products and services.

Responsibilities

• Conducts health risk assessments, including but not limited to physical, functional, social, psychological, environmental, learning, and financial needs of the member.
• Identifies problems, goals, and interventions to meet the member’s needs, including prioritized goals identified by the member and caregiver.
• Creates individualized care plans with the member, caregiver, and member’s Primary Care Provider (PCP), including short- and long-term goals and interventions.
• Provides appropriate interventions that demonstrate knowledge and sensitivity toward cultural diversity, religious and developmental considerations, health literacy, and educational backgrounds of the population served. Utilizes interpreter services as needed.
• Evaluates the member’s progress toward goal achievement, including identification and evaluation of barriers to meeting the member’s needs. Reassesses for changes in goals and/or health status.

Skills

Communication skills

English proficiency

Interdisciplinary collaboration

Case management

CMS/MCG knowledge

Nursing experience

Education

Associate degree or higher in nursing

Tools

Microsoft Office Suite

Job description

Imperial Health Plan in Pasadena, CA is seeking an Outpatient Case Manager to oversee intake and provide case management for members with chronic conditions and socioeconomic/mental health comorbidities.

Under the supervision of the Case Management Program Manager, you will develop individualized care plans, coordinate with PCPs and the care team, ensure HIPAA compliance, and strive to improve health outcomes.