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  • 6201 San Ignacio Avenue
    San Jose, CA 95119

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RN Case Manager

Santa Clara Family Health Plan • San Jose, CA

Posted 1 month ago

Job Snapshot

Full-Time
Experience - 3 years
Healthcare - Health Services
Health Care

Job Competition

7

Applicants

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Job Description

Consider a career at Santa Clara Family Health Plan (SCFHP), a public, not-for-profit, plan of over 250,000 members serving Santa Clara County.

GENERAL DESCRIPTION OF POSITION

The RN Case Manager is responsible for providing on-going case management services for Santa Clara Family Health Plan (SCFHP) members. As a SCFHP member advocate, the RN Case Manager facilitates communication and coordination among all participants of the care team to ensure member identified goals and needed services are provided to promote quality cost-effective outcomes. Through the development and implementation of member individualized care plans, the RN Case Manager provides medical and psychosocial case management support to help coordinate resources and services for individuals across the healthcare and social services continuum, and facilitate the use of available healthcare benefits in compliance with all applicable state and federal regulatory requirements, SCFHP policies and procedures, and business requirements.

ESSENTIAL DUTIES AND RESPONSIBILITIES

To perform this job successfully, an individual must be able to perform each essential duty listed below satisfactorily.

1. Conduct, review and document comprehensive clinical and/or psycho social assessments and on-going                follow-up interventions to measure progress towards meeting goals as they relate to a member’s physical, psycho social, environmental, safety, developmental, cultural and linguistic needs.

2. Maintain case files by assuring that they are documented in accordance with SCFHP policies and procedures,      state and federal requirements and organized in a manner that adheres to standards for audit requirements.

3. Facilitate involvement of the member and/or family/responsible party for development and implementation        of a member specific care plan which includes individualized prioritized goals.

4. Coordinate member’s care with PCP, Specialists, Behavioral Health and Long Term Services and Supports          providers to assist member to achieve or maintain a level of functional independence which allows them to        remain at home or in the community.

5. Facilitate and coordinate communication with member’s interdisciplinary care team including SCFHP internal      staff, as well as the member’s physicians, specialists, public services, community agencies and vendors to          ensure care plan development and coordination of benefits and services.

6. Facilitate successful transition of care for members who move between care settings by coordinating                  services for medical appointments, pharmacy assistance and by facilitating utilization review.

7. If assigned to MLTSS, support the transition of long-term care members residing in nursing facilities to a            lower level of care, or community setting in partnership with MLTSS providers and programs.

8. Conduct telephonic and/or visits/assessments, as needed in the home, facility or community setting.

9. Collaborate with team members on cross-departmental improvement efforts, quality improvement projects,       optimization of utilization management, and improvement of member satisfaction.

10. Attend and actively participate in Health Services meetings, operational meetings, training and coaching            sessions, including off-site meetings as needed.

11. Perform other duties as required or assigned.

Job Requirements

The requirements listed below are representative of the knowledge, skill, and/or ability required or desired.

1. Active California RN License without restriction. 

2. Minimum three years of experience in case management, discharge planning, or education or certifications,        or equivalent experience. 

3. Knowledge of managed care principles and practices with emphasis in Utilization Management and/or Case        Management. 

4. Clinical knowledge and critical thinking skills with the ability to assess individualized whole-person care               needs necessary to develop an effective care plan. 

5. Ability to consistently meet accuracy and timeline requirements to maintain regulatory compliance. 

6. Ability to work within an interdisciplinary team structure. 

7. Ability to conduct home, facility and other community-based visits. 

8. Maintenance of a valid California driver’s license and acceptable driving record, in order to drive to and              from offsite meetings or events; or ability to use other means of transportation to attend offsite meetings          or events. 

9. Proficient in adapting to changing situations and efficiently alternating focus between tasks to support the          operations as dictated by business needs. 

10. 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. 

11. Ability to use a keyboard with moderate speed and a high level of accuracy. 

12. Excellent communication skills including the ability to express oneself clearly and concisely when providing        service to SCFHP internal departments, members, providers and outside entities over the telephone, in              person or in writing as mandated by nursing scope of practice. 

13. Ability to think and work effectively under pressure and accurately prioritize and complete tasks within              established time frames. 

14. Ability to assume responsibility and exercise good judgment when making decisions within the scope of the        position. 

15. Ability to maintain confidentiality. 

16. Ability to comply with all SCFHP policies and procedures. 

17. Ability to perform the job safely and with respect to others, to property and to individual safety. 

DESIRED

1. Spanish, Vietnamese, Chinese, or Tagalog language bi-lingual skills. 

2. Experience working with designated member population (e.g. behavioral health, seniors and persons with          disabilities, children). 

BENEFITS

Santa Clara Family Health Plan offers a comprehensive benefits package including PTO, holidays, fitness center membership, medical, dental and vision coverage, CalPERS retirement, 401 a and 457 Deferred Compensation retirement plans.

                                                                           EOE

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