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Case Manager RN

Company: Clever Care Health Plan
Location: Huntington Beach
Posted on: July 25, 2022

Job Description:

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 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 Responsibilities

  • 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 management.
  • 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 members.
  • Uses motivational interviewing and Clever Care clinical guideposts to educate, support and motivate change during member contacts.
  • 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 good standing.
      • 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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