Medical Case Manager
Apply NowCompany: CA_CalOptima_Case Management
Location: Orange, CA 92867
Description:
Details
Client Name
CA_CalOptima_Case Management
Job Type
Travel
Offering
Nursing
Profession
LPN/LVN
Specialty
LPN / LVN
Job ID
16136522
Job Title
Medical Case Manager
Weekly Pay
$2180.0
Shift Details
Shift
08:00 AM - 05:00 PM
Scheduled Hours
40
Job Order Details
Start Date
03/06/2025
End Date
05/31/2025
Duration
13 Week(s)
Job Description
Due Date- 03/06/2025
Summary: Temp position for Case Management support.
Description:
CalOptima Health is seeking a highly motivated an experienced TEMPORARY - Medical Case Manager to join our team. Case Management is an advanced specialty collaborative practice responsible for providing ongoing case management services for CalOptima Health's members. The Medical Case Manager will facilitate communication and coordination among all participants of the health care team and CalOptima Health's members to ensure the services provided promote quality and cost-effective outcomes for all members. The incumbent will be responsible for providing intensive case management, which includes assessment, planning, implementation, coordination, monitoring and evaluation of the member's needs.
Position Information:
Department: Case Management
Salary Grade: 313 - $90,820 - $145,312 ($43.66 - $69.8615)
Work Arrangement: Full Office
Work Schedule: Monday to Friday (8:00 am to 5:00 pm)
Submission Information:
The deadline to be guaranteed full review of your submission is due by Thursday, March 6, 2025 by 9:00 p.m. PST. This position will remain open for a minimum of seven (7) days, but may be extended if a lack of qualified applicants are received or if we are hiring multiple positions.
Duties & Responsibilities:
85% - Care Management
oAssesses member needs using a standardized health needs assessment or health risk assessment.
oPerforms comprehensive, disease specific, clinical assessments of all identified cases, which includes but is not limited to, assessment of:
Member's physical, functional, social and psychological status
Member's cultural and linguistic needs
Caregiver resources and available benefits
oPerforms post-discharge assessments to identify member's post-hospital or post-emergency department discharge needs including but not limited to:
Member's physical, functional, social and psychological status
Member's cultural and linguistic needs
Caregiver resources and available benefits
Follow-up provider care and ensuring scheduled appointments
Durable medical equipment and supplies
Community resources
oDevelops and implements a member's specific care plan which includes prioritized Specific, Measurable, Achievable, Relevant, and Time-Bound (SMART) goals.
oReviews, modifies and updates care plans continuously to reflect the member's needs, at minimum, annually or upon change in condition.
oSchedules follow-ups to assess progress towards goals and identifies barriers to meeting goal. Provides regular outreach to assigned members along with members from a worklist and evaluates quality of service given to members according to department contact standards.
oCoordinates care and services with members, members' family members/representatives and other providers, as appropriate, including community supports and Long-Term Services and Supports (LTSS).
oCommunicates with member's physicians, specialists, community agencies and vendors to ensure coordination of services.
oFacilitates referrals to behavioral health/substance use disorder services and identifies and makes referrals to LTSS department, community supports and community resources.
oFacilitates and participates in Interdisciplinary Team meetings as applicable.
oCollaborates with interdepartmental staff in case resolution as needed.
oIdentifies cases needing supervisor, manager, director or medical director review or input, routes accordingly and closes cases according to procedures and guidelines in a timely manner.
oAdvocates in the member's best interest for necessary funding, treatment alternatives, timelines and coordination of care and frequent evaluations of progress and goals.
10% - Administrative Support
oParticipates in a mission driven culture of high-quality performance, with a member focus on customer service, consistency, dignity and accountability.
oAssists the team in carrying out department responsibilities and collaborates with others to support short- and long-term goals/priorities for the department.
oFollows CalOptima Health's protocol for documenting all case interventions.
oPrepares and maintains appropriate documentation of patient care and progress within the care plan.
5% - Completes other projects and duties as assigned.
Minimum Qualifications:
Associate degree in nursing (ADN) or related field required PLUS 3 years of clinical experience and/or managed care experience required; an equivalent combination of education and experience sufficient to successfully perform the essential duties of the position such as those listed above may also be qualifying.
Preferred Qualifications:
Bachelor of Science in Nursing (BSN) degree or related field.
Case Management Certification (CCM).
Bilingual in English and one of CalOptima Health's defined threshold languages (Arabic, Chinese, Farsi, Korean, Spanish, Vietnamese).
Required Licensure / Certifications:
Current, unrestricted Registered Nurse (RN) license to practice in the state of California required.
Knowledge & Abilities:
Develop rapport and establish and maintain effective working relationships with CalOptima Health's leadership and staff and external contacts at all levels and with diverse backgrounds.
Work independently and exercise sound judgment.
Communicate clearly and concisely, both orally and in writing.
Work a flexible schedule; available to participate in evening and weekend events.
Organize, be analytical, problem-solve and possess project management skills.
Work in a fast-paced environment and in an efficient manner.
Manage multiple projects and identify opportunities for internal and external collaboration.
Motivate and lead multi-program teams and external committees/coalitions.
Utilize computer and appropriate software (e.g., Microsoft Office: Word, Outlook, Excel, PowerPoint) and job specific applications/systems to produce correspondence, charts, spreadsheets, and/or other information applicable to the position assignment.
Physical Requirements (With or Without Accommodations):
Ability to visually read information from computer screens, forms and other printed materials and information.
Ability to speak (enunciate) clearly in conversation and general communication.
Hearing ability for verbal communication/conversation/responses via telephone, telephone systems, and face-to-face interactions.
Manual dexterity for typing, writing, standing and reaching, flexibility, body movement for bending, crouching, walking, kneeling and prolonged sitting.
Lifting and moving objects, patients and/or equipment 10 to 25 pounds
Work Environment:
If located at the 500, 505 Building or a remote work location:
Work is typically indoors and sedentary and is subject to schedule changes and/or variable work hours, with travel as needed.
There are no harmful environmental conditions present for this job.
The noise level in this work environment is usually moderate.
If located at PACE:
Work is typically indoors in a clinical setting serving the frail and elderly.
There may be harmful or hazardous environmental conditions present for this job.
The noise level in this work environment is usually moderate to loud.
If located in the Community:
Work is typically indoors and sedentary and is subject to schedule changes and/or variable work hours, with travel as needed.
Employee will occasionally work outdoors in varied temperatures.
There may be harmful or hazardous environmental conditions present for this job.
The noise level in this work environment is usually moderate to loud.
Client Details
Address
505 City Parkway West
City
Orange
State
CA
Zip Code
92868
Client Name
CA_CalOptima_Case Management
Job Type
Travel
Offering
Nursing
Profession
LPN/LVN
Specialty
LPN / LVN
Job ID
16136522
Job Title
Medical Case Manager
Weekly Pay
$2180.0
Shift Details
Shift
08:00 AM - 05:00 PM
Scheduled Hours
40
Job Order Details
Start Date
03/06/2025
End Date
05/31/2025
Duration
13 Week(s)
Job Description
Due Date- 03/06/2025
Summary: Temp position for Case Management support.
Description:
CalOptima Health is seeking a highly motivated an experienced TEMPORARY - Medical Case Manager to join our team. Case Management is an advanced specialty collaborative practice responsible for providing ongoing case management services for CalOptima Health's members. The Medical Case Manager will facilitate communication and coordination among all participants of the health care team and CalOptima Health's members to ensure the services provided promote quality and cost-effective outcomes for all members. The incumbent will be responsible for providing intensive case management, which includes assessment, planning, implementation, coordination, monitoring and evaluation of the member's needs.
Position Information:
Department: Case Management
Salary Grade: 313 - $90,820 - $145,312 ($43.66 - $69.8615)
Work Arrangement: Full Office
Work Schedule: Monday to Friday (8:00 am to 5:00 pm)
Submission Information:
The deadline to be guaranteed full review of your submission is due by Thursday, March 6, 2025 by 9:00 p.m. PST. This position will remain open for a minimum of seven (7) days, but may be extended if a lack of qualified applicants are received or if we are hiring multiple positions.
Duties & Responsibilities:
85% - Care Management
oAssesses member needs using a standardized health needs assessment or health risk assessment.
oPerforms comprehensive, disease specific, clinical assessments of all identified cases, which includes but is not limited to, assessment of:
Member's physical, functional, social and psychological status
Member's cultural and linguistic needs
Caregiver resources and available benefits
oPerforms post-discharge assessments to identify member's post-hospital or post-emergency department discharge needs including but not limited to:
Member's physical, functional, social and psychological status
Member's cultural and linguistic needs
Caregiver resources and available benefits
Follow-up provider care and ensuring scheduled appointments
Durable medical equipment and supplies
Community resources
oDevelops and implements a member's specific care plan which includes prioritized Specific, Measurable, Achievable, Relevant, and Time-Bound (SMART) goals.
oReviews, modifies and updates care plans continuously to reflect the member's needs, at minimum, annually or upon change in condition.
oSchedules follow-ups to assess progress towards goals and identifies barriers to meeting goal. Provides regular outreach to assigned members along with members from a worklist and evaluates quality of service given to members according to department contact standards.
oCoordinates care and services with members, members' family members/representatives and other providers, as appropriate, including community supports and Long-Term Services and Supports (LTSS).
oCommunicates with member's physicians, specialists, community agencies and vendors to ensure coordination of services.
oFacilitates referrals to behavioral health/substance use disorder services and identifies and makes referrals to LTSS department, community supports and community resources.
oFacilitates and participates in Interdisciplinary Team meetings as applicable.
oCollaborates with interdepartmental staff in case resolution as needed.
oIdentifies cases needing supervisor, manager, director or medical director review or input, routes accordingly and closes cases according to procedures and guidelines in a timely manner.
oAdvocates in the member's best interest for necessary funding, treatment alternatives, timelines and coordination of care and frequent evaluations of progress and goals.
10% - Administrative Support
oParticipates in a mission driven culture of high-quality performance, with a member focus on customer service, consistency, dignity and accountability.
oAssists the team in carrying out department responsibilities and collaborates with others to support short- and long-term goals/priorities for the department.
oFollows CalOptima Health's protocol for documenting all case interventions.
oPrepares and maintains appropriate documentation of patient care and progress within the care plan.
5% - Completes other projects and duties as assigned.
Minimum Qualifications:
Associate degree in nursing (ADN) or related field required PLUS 3 years of clinical experience and/or managed care experience required; an equivalent combination of education and experience sufficient to successfully perform the essential duties of the position such as those listed above may also be qualifying.
Preferred Qualifications:
Bachelor of Science in Nursing (BSN) degree or related field.
Case Management Certification (CCM).
Bilingual in English and one of CalOptima Health's defined threshold languages (Arabic, Chinese, Farsi, Korean, Spanish, Vietnamese).
Required Licensure / Certifications:
Current, unrestricted Registered Nurse (RN) license to practice in the state of California required.
Knowledge & Abilities:
Develop rapport and establish and maintain effective working relationships with CalOptima Health's leadership and staff and external contacts at all levels and with diverse backgrounds.
Work independently and exercise sound judgment.
Communicate clearly and concisely, both orally and in writing.
Work a flexible schedule; available to participate in evening and weekend events.
Organize, be analytical, problem-solve and possess project management skills.
Work in a fast-paced environment and in an efficient manner.
Manage multiple projects and identify opportunities for internal and external collaboration.
Motivate and lead multi-program teams and external committees/coalitions.
Utilize computer and appropriate software (e.g., Microsoft Office: Word, Outlook, Excel, PowerPoint) and job specific applications/systems to produce correspondence, charts, spreadsheets, and/or other information applicable to the position assignment.
Physical Requirements (With or Without Accommodations):
Ability to visually read information from computer screens, forms and other printed materials and information.
Ability to speak (enunciate) clearly in conversation and general communication.
Hearing ability for verbal communication/conversation/responses via telephone, telephone systems, and face-to-face interactions.
Manual dexterity for typing, writing, standing and reaching, flexibility, body movement for bending, crouching, walking, kneeling and prolonged sitting.
Lifting and moving objects, patients and/or equipment 10 to 25 pounds
Work Environment:
If located at the 500, 505 Building or a remote work location:
Work is typically indoors and sedentary and is subject to schedule changes and/or variable work hours, with travel as needed.
There are no harmful environmental conditions present for this job.
The noise level in this work environment is usually moderate.
If located at PACE:
Work is typically indoors in a clinical setting serving the frail and elderly.
There may be harmful or hazardous environmental conditions present for this job.
The noise level in this work environment is usually moderate to loud.
If located in the Community:
Work is typically indoors and sedentary and is subject to schedule changes and/or variable work hours, with travel as needed.
Employee will occasionally work outdoors in varied temperatures.
There may be harmful or hazardous environmental conditions present for this job.
The noise level in this work environment is usually moderate to loud.
Client Details
Address
505 City Parkway West
City
Orange
State
CA
Zip Code
92868