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- San Bernardino, CA
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RN (Registered Nurse) (Care Manager)
Maxim Healthcare Services • San Bernardino, CA
Posted 17 days ago
Under the general direction of the Care Management Manager, the Care Manager is responsible for working directly with the Plan, IPA medical groups, providers, hospitals, community agencies, Members/caregivers, and other entities supporting Member care to ensure coordinated, continuous care and serve as a resource person to these facilities. The RN Care Manager supports the care team, finalizes the care management assessment and Individualized Care Plan (ICP).
- Responsible for serving as a resource for Members and Providers for care management and continuity of care.
- Responsible for assessing Members for appropriate care management needs including •
- Conducting a clinical assessment and medication reconciliation.
- Develop, implement, and evaluate Individualized Care Plans (ICP)
- Act as a Member advocate
- Serve as a liaison between Member, caregivers, and providers
- Educate and support Members/caregivers with meeting ICP goals
- Identify need for Interdisciplinary Care Team (ICT), organize the participants to be included and ensure facilitation and documentation of the ICT.
- Review and revise contributions to assessment information and care planning from care team members (i.e. LVN Care Manager, Care Coordinator) as appropriate.
- Assist with referrals for Members that are eligible for carve out programs such as CCS, multi-organ transplant, etc
- Assist members with immediate needs with regard to access, referrals and authorizations.
- Assist member with resources such as LTSS, Independent Living and Diversity Services, Behavioral Health, and Community Resources
- Responsible for any other duties as required ensuring successful care management processes and Member outcomes using critical thinking and innovative techniques to engage and retain Members in the CM program.
- Any other duties as required or assigned to ensure Health Plan operations are successful.
- Ensure the privacy and security of PHI (Protected Health Information) as outlined in the policies and procedures relating to HIPAA compliance.
Education/License: Possession of a valid RN issued by the State of California Possession of a valid State of California driver’s license.
Experience: Three (3) or more years of care management experience in a health care delivery setting. Experience in an HMO or experience in Managed Care setting preferred. Minimum 1 year clinical experience in an acute care facility, skilled nursing facility, home health or clinic setting preferred.
- Competitive pay & weekly paychecks
- Health, dental, vision, and life insurance
- 401(k) savings plan
- Awards and recognition programs