Job Summary:
The Health Plan Nurse Coordinator (HPNC - CM) is a Registered Nurse who is assigned to Case Management programs. This position reports to the Case Management Manager or their designee. Depending on unit assignment, the HPNC may perform utilization management activities, which may include telephonic or onsite clinical review; case or disease management, care coordination or transition, or population health activities; or a combination of all. The HPNC may be assigned to sub-specialized programs within an operational unit, such as Mental/Behavioral Health services. These sub-specialized programs require the RN to perform UM or CM activities for a specific member population. Bilingual in Spanish is required for this position.
Responsibilities:
· Comply with HIPAA, Privacy, and Confidentiality laws and regulations
· Adhere to Health Plan, Medical Management and Health Services policies and procedures
· Be abreast on clinical knowledge related to disease processes
· Effectively communicate, verbally and in writing, with providers, members, vendors, and other health care providers and in a timely, respectful and professional manner
· Function as a collaborative member of Medical Management/Health Services’
multi-disciplinary medical management team
· Identify and report quality of care concerns to management and as directed, to appropriate CenCal Health department for follow up
· Support and collaborate with the management, medical management and health services team members in the implementation and management of Utilization Management, Case Management, Disease Management, Population Health, Care Coordination, and Care Transition activities
· As required, actively participate in the implementation, assessment, and evaluation of quality improvement activities as it relates to job duties
· Adhere to mandated reporting requirements appropriate to professional licensing requirements
· Comply with regulatory standards of governing agency
· Be positive, flexible, and open toward operational changes
Skills:
· Professional demeanor
· Demonstrate strong multi-tasking, organizational, and time-management skills
· Demonstrate clinical knowledge of either adult or pediatric health conditions and disease processes, (depending on assignment)
· Able to work effectively individually and collaboratively in a cross-functional team environment
· Able to communicate professionally by phone, with members and their families, physicians, providers, and other health care providers; in writing, and in-person (in an one-to-one or group setting) and to demonstrate excellent interpersonal communication skills
· Able to compose clear, professional, and grammatically correct correspondence to members and providers
· Able to meet timelines/deadlines of daily work responsibilities and, as assigned, for long-term projects
· Demonstrate proficiency in utilizing CM database and its related software and modules
· Demonstrate proficiency in the development, implementation and outcome measurement of Individualized Care Plans (ICP)
· Evidence that ICPs are developed in a timely manner, clear and concise, member-centric, and have limited changes to goal/outcome completion timeline
· Categorize cases in the correct program, program type, acuity and intensity
· Proficient understanding of Medi-Cal coverage and limitations
· Act as a mentor to new HPNC in Case Management
If you are a compassionate individual with a background in healthcare and a desire to make a difference in people's lives, we encourage you to apply for this rewarding position as a Case Manager.
Job Type: Full-time
Pay: $39.50 - $52.00 per hour
Expected hours: 40 per week
Benefits:
- 401(k)
- Dental insurance
- Health insurance
- Vision insurance
Medical specialties:
Standard shift:
Weekly schedule:
License/Certification:
- RN License in CA (Required)
Work Location: Remote