Location: Orange, California US
Job Number: 1954
Position Title: Case Manager
The Nurse Case Manager is responsible for health care management and care coordination within the scope of licensure for members with complex and chronic care needs. The Nurse Case Manager plans and delivers care to members utilizing the nursing process of assessment, care planning, intervention, and evaluation; and effectively interacts with members, care givers, and other interdisciplinary team participants. To support the care planning process, the Nurse Case Manager will conduct comprehensive assessments that include the medical, behavioral, pharmaceutical and social needs of the member, identify gaps in care, and barriers to attaining improved health. Based on the comprehensive assessment, and in conjunction with the member, the member’s physician and other participants of the health care team, the Nurse Case Manager will create and implement a care plan that addresses the identified needs and work to remove barriers to improve the health of the member.
The Nurse Case Manager will connect with members telephonically.
(May include but are not limited to)
- Coordinate care by serving as a resource for the member, their family and their physician.
- Measure, improve and maintain quality outcomes (clinical, financial, and functional) for individual members and the population served.
- Ensure access to appropriate care for members with urgent or immediate needs facilitating referrals/authorizations within the benefit structure as appropriate.
- Assesses the member's current health status, resource utilization, past and present treatment plan and services.
- Collaborates with the member, the PCP and other participants of the care team to develop a plan of care.
- Monitors and evaluates effectiveness of the care management plan and modifies as necessary.
- Interfaces with Primary Care Physicians, Hospitalists, Nurse Practitioners and specialists on the development of care management treatment plans.
- Provide education and self-management support based on the member’s unique learning style.
- Assists in problem solving with providers, claims or service issues.
- Works closely with delegated or contracted providers, groups or entities (as assigned) to assure effective and efficient care coordination.
- Maintains confidentiality of all PHI in compliance with state and federal law and Alignment Healthcare Policy.
- Minimum Experience:
- 1-3 years clinical experience
- 3 or more years of case management experience; or any combination of education and experience, which would provide an equivalent background.
- Health Plan experience preferred
- Must have and maintain an active, valid and unrestricted RN license in the state for which you are applying
- Case Management Certification preferred
- Possess a high level of understanding of community resources, treatment options, home health, funding options and special programs
- Extensive knowledge of the management of chronic conditions
- Excellent verbal and written communications skills
- Excellent case preparation and abstracting skills
- Team player who builds effective working relationships
- Ability to work independently
- Experience using standardized clinical guidelines required
- Strong organizational skills
- Ability to operate PC-based software programs including proficiency in Word, Excel and PowerPoint
Essential Physical Functions:
The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
- While performing the duties of this job, the employee is regularly required to talk or hear. The employee regularly is required to stand, walk, sit, use hand to finger, handle or feel objects, tools, or controls; and reach with hands and arms.
- The employee frequently lifts and/or moves up to 10 pounds. Specific vision abilities required by this job include close vision and the ability to adjust focus.
Location City: Orange
Location State: California
Community / Marketing Title: Case Manager
Who is Alignment Healthcare?
- Socially responsible
- Technologically enabled
- Concierge care
- Servant leadership
We are dedicated to transforming the complex and confusing process of medical treatment in the United States so that every link in the health care continuum becomes more efficient, productive, and effective. We built a team of people who want to make a difference. Come join the team that is changing health care one person at a time.
We believe that great work comes from people who are inspired to be their best. We invite you to explore our wide variety of roles based on your unique experience.