Case Manager RN
Company: Clever Care Health Plan
Location: Huntington Beach
Posted on: July 25, 2022
Candidate must reside in California, Nevada, Texas, or New
York.About Clever Care Health PlanClever Care Health Plan is a
Medicare Advantage health plan currently serving Medicare
beneficiaries in Southern California. Our employees are passionate
in providing best services to our members and healthcare providers.
We deliver on our commitment to our members' health and well-being
by offering plans that connect the benefits of Eastern and Western
medicine. To learn more, please visit CleverCareHealthPlan.com.Job
SummaryClever Care Health Plan (Clever Care) works with members,
providers and multidisciplinary team members to assess, facilitate,
plan and coordinate an integrated delivery of care across the
continuum, including behavioral health and long-term care, for
members with high need potential. Clever Care staff work to ensure
that patients progress toward desired outcomes with quality care
that is medically appropriate and cost-effective based on the
severity of illness and the site of service.Functions & Job
- Completes comprehensive assessments of members per regulated
timelines and determines who may qualify for case management based
on clinical judgment, changes in member's health or psychosocial
wellness, and triggers identified in the assessment.
- Develops and implements a case management plan in collaboration
with the member, caregiver, physician and/or other appropriate
healthcare professionals and member's support network to address
the member needs and goals.
- Conducts face-to-face or home visits as required.
- Performs ongoing monitoring of the care plan to evaluate
effectiveness, document interventions and goal achievement, and
suggest changes accordingly.
- Maintains ongoing member case load for regular outreach and
- Promotes integration of services for members including
behavioral health care and long-term services and supports/home and
community to enhance the continuity of care for Clever Care
- Uses motivational interviewing and Clever Care clinical
guideposts to educate, support and motivate change during member
- Assesses for barriers to care, provides care coordination and
assistance to member to address concerns.
- RNs provide consultation, recommendations and education as
appropriate to non-RN case managers.
- RNs are assigned cases with members who have complex medical
conditions and medication regimens
- RNs conduct medication reconciliation when
needed.QualificationsEducation & Experience:
- Graduate from an Accredited School of Nursing. Bachelor's
Degree in Nursing preferred.
- 1-3 years in case management, disease management, managed care
or medical or behavioral health settings.Skills:
- Active, unrestricted State Registered Nursing (RN) license in
- Certified Case Manager (CCM) preferredPhysical & Working
Environment.Typical Physical Demands.Position requires a great
amount of sitting. Some standing, stooping, bending or reaching is
required. May require lifting up to 15 pounds. Requires manual
dexterity sufficient to operate a computer, calculator and
telephone. Requires normal range of hearing and vision. Requires
the ability to type and file.Typical Working Conditions.Work is
performed in an office environment and/or remotely. The job
involves frequent contact with staff and public. Work may be
stressful at times. May occasionally work some irregular
hours.Clever Care Health Plan is proud to be an Equal Employment
Opportunity and Affirmative Action workplace. Individuals seeking
employment will receive consideration for employment without regard
to race, color, national origin, religion, age, sex (including
pregnancy, childbirth or related medical conditions), sexual
orientation, gender perception or identity, age, marital status,
disability, protected veteran status or any other status protected
by law. A background check is required.
Keywords: Clever Care Health Plan, Huntington Beach , Case Manager RN, Executive , Huntington Beach, California
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