Care Coordination Case Manager I, Fairfield, CA
Care Coordination Case Manager I
To initiate and coordinate a multidisciplinary team approach to case management with members, health care providers, Partnership HealthPlan of California, and any patient identified health care designee. Collaborates, assesses, plans, facilitates, evaluates, and advocates in order to meet the comprehensive medical, behavioral, and psychosocial needs of the member, while promoting quality and cost-effective outcomes.
ESSENTIAL DUTIES AND RESPONSIBILITIES
- Initiates and coordinates individualized care plan addressing both clinical and non-clinical components, ensuring the care plan is available to both the member and primary care
- Ensures a smooth implementation and continuum of care via effective and frequent communication with providers, members, and identified health care
- Estimates costs, time frames, and resources required to implement quality, cost-effective plan of
- Coordinates referrals and authorizations for services required to improve the member's health
- Collaborates and coordinates with other internal departments to identify members suitable for case
- Maintains accurate and timely documentation, records, and case files in the PHC Case Management System for members in case
- Coordinates activities, education, and services for PHC members in Disease Management
- Possesses ability to assertively and diplomatically distribute referrals for
- Coordinates and participates in weekly/quarterly meetings with PHC
- Notifies Claims department of benefit decisions and CM
- Other duties as assigned.
MINIMUM HIRING CRITERIA
Education and Experience
3-5 years of experience to include at least one (1) year of case management experience and one (1) year in an acute care setting; or equivalent combination of education and experience. Desired experience in mental health. General knowledge of managed care with emphasis in UM or CM preferred. Experience in mental health is desired.
Special Skills, Licenses and Certifications
Current California Registered Nurse License, LVN or health related certification i.e MSW, LCSW are considered. Valid California driver’s license and proof of current automobile insurance compliant with PHC policy are required to operate a vehicle and travel for company business.
Performance Based Competencies
Ability to work within an interdisciplinary structure and function independently in a fast-paced environment while managing multiple priorities and meeting deadlines. Effective telephone and computer data entry skills required.
Work Environment And Physical Demands
Daily use of telephone and computer for most of the day. Standard cubicle workstation. Must be able to lift, move, or carry objects of varying size, weighing up to 10 lbs.
All HealthPlan employees are expected to:
- Provide the highest possible level of service to clients;
- Promote teamwork and cooperative effort among employees;
- Maintain safe practices; and
- Abide by the HealthPlan’s policies and procedures, as they may from time to time be updated.
IMPORTANT DISCLAIMER NOTICE
The job duties, elements, responsibilities, skills, functions, experience, educational factors and the requirements and conditions listed in this job description are representative only and not exhaustive or definitive of the tasks that an employee may be required to perform. The employer reserves the right to revise this job description at any time and to require employees to perform other tasks as circumstances or conditions of its business, competitive considerations, or work environment change.
Fairfield, California, United States
Additional Preferred Skills