X - As-Needed / Temp - Medical Case Manager, MSSP

CalOptima; Orange (CA); On-site; USD 91,000 - 145,000; Full time

Job summary

CalOptima Health seeks an X- As-Needed / Temp - Medical Case Manager for MSSP. The role emphasizes 90% case management, assessments of medical, psychosocial, and environmental factors, and care planning with the MSSP team.

The nurse will navigate home and community settings to support complex needs within a mission-driven culture. The position requires an ADN with 3+ years of clinical experience, CA RN licensure, strong communication, and ability to travel up to 50% of the time to support

Qualifications

• Associate degree in nursing (ADN) plus 3 years of clinical experience required.
• RN license to practice in California. Valid driver's license and vehicle required for travel 50% or more.

Responsibilities

• 90% - Case Management within MSSP program.
• Assess member status via in-field, virtual, or telephonic methods.
• Develop and update individualized care plans with IDT involvement.
• Coordinate with family, physicians, and providers to support care.
• Advocate for benefit coverage and access to care.
• Complete other duties as assigned.

Skills

Case Management

Communication

Independent Work

Project Management

Team Collaboration

Problem Solving

Microsoft Office

Education

Associate degree in nursing

Tools

Microsoft Office

Job description

X - As-Needed / Temp - Medical Case Manager, MSSP

CalOptima

Position Information:

• - Department: MSSP - Direct Support
• - Salary Grade: 313 - $90,820 - $145,312 ($43.66 - $69.8615)
• - Work Arrangement: Full Office
• - Work Schedule: Monday through Friday; 8:00 a.m. to 5:00 p.m.
• - Expected Assignment Duration: up to sixty (60) days; may be extended based on business need, not to exceed six (6) months

Submission Information:

• - This position will remain open for a minimum of seven (7) days, but may be extended if a lack of qualified applicants are received or if we are hiring multiple positions.

Duties & Responsibilities:

• - 90% - Case Management
• - Participates in a mission-driven culture of high-quality performance, with a member focus on customer service, consistency, dignity and accountability.
• - Assists the team in carrying out department responsibilities and collaborates with others to support short- and long-term goals/priorities for the department.
• - Conducts in-field, virtual or telephonic assessments of each member's current status, including physical, psychosocial and environmental conditions.
• - Navigates the sensitivities of completing care management work in the private residences of members.
• - Builds and maintains rapport with members from diverse backgrounds to foster effective care management relationships that support the member's coping with complex medical, behavioral and social needs.
• - Gathers and reviews all information pertinent to each member's case, including medical documentation covering medical, health and rehabilitation concerns. Records the information and clinical impressions.
• - Certifies clinical level of care determinations per the California Code of Regulations (CCR), Title 22 Sections 51334 and 51335, for each eligible applicant for whom there are reasonable indications that MSSP services are required and justified.
• - Assesses and communicates each member's status and progress through participation in the program. If progress becomes static or regressive, determines cause and proactively makes appropriate adjustments in the care plan, providers and services to promote better outcomes.
• - Identifies and responds to member crisis situations by promptly prioritizing and implementing appropriate interventions.
• - Initiates and maintains appropriate contact with each member's family members, treating physicians and other health care professionals to coordinate relevant information that supports the member's functioning and coping in the community.
• - Develops, implements and updates each member's individualized care plan through the interdisciplinary team (IDT) process in conjunction with the member and family, the supervising care manager and the MSSP Social Worker across the full continuum of care.
• - Collaborates with professionals across various disciplines involved in the member's care, including those in community agencies, with an emphasis on interpreting and problem-solving the complex barriers to the member's preferred care plan goals.
• - Tracks each member's quality of care and quality of life improvements, as measured against the established care plan goals.
• - Advocates in the member's best interest regarding the necessary benefit coverage, treatment alternatives and access to care.
• - 10% - Other
• - Completes other projects and duties as assigned.

Minimum Qualifications:

• - Associate degree in nursing (ADN) PLUS 3 years of clinical experience working with the health needs of the population served required with preferably 2 years of experience working in public health with older adults; an equivalent combination of education and experience sufficient to successfully perform the essential duties of the position such as those listed above may also be qualifying.
• - Valid driver's license and vehicle, an acceptable driving record and current auto insurance or other approved means of transportation, will be required for work away from the primary office 50% of the time or more.

Preferred Qualifications:

• - Bachelor of Science in Nursing (BSN).
• - Case Management Certification (CCM).
• - Public Health Nurse (PHN) certification.
• - Experience in home health, hospice or skilled nursing facility and Level of Care Certification process experience.
• - Bilingual in English and in one of CalOptima Health's defined threshold languages (Arabic, Farsi, Chinese, Korean, Russian, Spanish, Vietnamese).

Required Licensure / Certifications:

• - Current unrestricted Registered Nurse (RN) license to practice in the state of California required.

Knowledge & Abilities:

• - Develop rapport and establish and maintain effective working relationships with CalOptima Health's leadership and staff and external contacts at all levels and with diverse backgrounds.
• - Work independently and exercise sound judgment.
• - Communicate clearly and concisely, both orally and in writing.
• - Work a flexible schedule; available to participate in evening and weekend events.
• - Organize, be analytical, problem-solve and possess project management skills.
• - Work in a fast-paced environment and in an efficient manner.
• - Manage multiple projects and identify opportunities for internal and external collaboration.
• - Motivate and lead multi-program teams and external committees/coalitions.
• - Utilize computer and appropriate software (e.g., Microsoft Office: Word, Outlook, Excel, PowerPoint) and job specific applications/systems to produce correspondence, charts, spreadsheets, and/or other information applicable to the position assignment.

Physical Requirements (With or Without Accommodations):

• - Ability to visually read information from computer screens, forms and other printed materials and information.
• - Ability to speak (enunciate) clearly in conversation and general communication.
• - Hearing ability for verbal communication/conversation/responses via telephone, telephone systems, and face-to-face interactions.
• - Manual dexterity for typing, writing, standing and reaching, flexibility, body movement for bending, crouching, walking, kneeling and prolonged sitting.
• - Lifting and moving objects, patients and/or equipment 10 to 25 pounds

Work Environment:

• - If located at the 500, 505 Building or a remote work location:
• - Work is typically indoors and sedentary and is subject to schedule changes and/or variable work hours, with travel as needed.
• - There are no harmful environmental conditions present for this job.
• - The noise level in this work environment is usually moderate.
• - If located at PACE:
• - Work is typically indoors in a clinical setting serving the frail and elderly.
• - There may be harmful or hazardous environmental conditions present for this job.
• - The noise level in this work environment is usually moderate to loud.
• - If located in the Community:
• - Work is typically indoors and sedentary and is subject to schedule changes and/or variable work hours, with travel as needed.
• - Employee will occasionally work outdoors in varied temperatures.
• - There may be harmful or hazardous environmental conditions present for this job.
• - The noise level in this work environment is usually moderate to loud.

CalOptima Health is an equal opportunity employer and makes all employment decisions on the basis of merit. CalOptima Health wants to have qualified employees in every job position. CalOptima Health prohibits unlawful discrimination against any employee, or applicant for employment, based on race, religion/religious creed, color, national origin, ancestry, mental or physical disability, medical condition, genetic information, marital status, sex, sex stereotype, gender, gender identity, gender expression, transitioning status, age, sexual orientation, immigration status, military status as a disabled veteran, or veteran of the Vietnam era, or any other consideration made unlawful by federal, state, or local laws. CalOptima Health also prohibits unlawful discrimination based on the perception that anyone has any of those characteristics or is associated with a person who has, or is perceived as having, any of those characteristics.

If you are a qualified individual with a disability or a disabled veteran, you may request a reasonable accommodation at [phone] if you are unable or limited in your ability to access job openings or apply for a job on this site as a result of your disability.

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