RN Case Manager; live in Los Angeles

Case Manager

The Case Manager has the responsibility to identify, assess, plan, coordinate, implement, monitor, and evaluate options and services for individuals requiring case management services. The goal of the case manager is to provide for quality, cost-effective outcomes for the client through collaboration and communication with the client, the family, the physician, and other members of the health care team. This is not a 100% remote position.

Responsibilities include the following:

• Processes the case utilizing client's outcome management model and tools
• Obtains written authorization for case management services as well as release of information
• Assesses the client/family to identify their strengths and resources; problems; psychosocial, financial, and medical history; current status; diagnosis; prognosis; functional status; goals; current treatment plan; and needs
• Develops a plan of care with client's model through interdisciplinary collaboration, which identifies realistic short- and long-term goals
• Identifies, secures, and coordinates the services and resources to implement the plan
• Monitors services being provided for continued appropriateness and reports to client and carrier
• Evaluates the client's progress, the plan, and the appropriateness of the services provided, with modifications as necessary
• Provides ongoing instruction to the client and family regarding the injury/disease process, treatment options, and present care
• Promotes the client's/family's self-advocacy skills to achieve maximum self-sufficiency
• Has knowledge of the benefit package as well as all available funding sources and systems of care and coordinates with the payer for authorization of payment
• Provides for in-depth reporting of outcomes encompassing clinical, functional, financial, and customer satisfaction areas
• Demonstrates effective, accurate, and timely verbal and written communication in all work situations
• Identifies and discloses all situations which might result in exposure to legal liability and/or are indicative of poor quality care negatively affecting the client
• Frequently requires travel to patient appointments.
• Performs other related duties as assigned in accordance with the necessary job function

This position has no supervisory responsibilities.

This position requires regular contact both within the company and outside the company in order to carry out company policies and procedures. Requires abilities of persuasion and cooperation. Often deals with persons of equal or higher rank.

This position requires frequent decision making and the ability to plan and perform unusual or difficult work with general operation methods/procedures.

This position exercises considerable latitude in determining objectives and approach to assignments. Completed work is reviewed from a long-term perspective for desired results.

To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill, and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

Education and/or

Experience:

• Registered nurse
• BSN preferred
• CCM or equivalent certification
• Three years or more of related experience and/or training or equivalent combination of education and experience

Language

Skills:

• Ability to read, analyze, and interpret medical information, professional journals, technical procedures, governmental regulations, and standards of care
• Ability to effectively present information and respond to questions from customers, managers, and clients as appropriate

Mathematical

Skills:

• Ability to add, subtract, multiply, and divide in all units of measure, using whole numbers, common fractions, and decimals
• Ability to compute rate, ratio, and percent and to draw and interpret bar graphs

Reasoning Ability:

• Ability to solve practical problems and deal with a variety of concrete variables in situations where only limited standardization exists
• Ability to interpret a variety of instructions furnished in written, oral, diagram, or schedule form

Computer

Skills:

• Knowledge of database software, internet software, and Microsoft word processing software

Certificates, Licenses, Registrations:

• RN license in state(s) where cases are to be managed
• Valid driver's license
• Valid automobile liability insurance

Other

Skills and Abilities:

• Ability to organize and evaluate workload and prioritize projects
• Ability to meet deadlines
• Ability to complete multiple, simultaneous projects with accuracy and efficiency
• Detail orientation
• Contract-level acceptance by client of the Case Manager to manage their cases

The physical demands described are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodation may be made to enable individuals with disabilities to perform the essential functions.

While performing the duties of this job, the employee regularly is…