Case Manager Nurse

The expected pay range is based on many factors such as geography, experience, education, and the market. The range is subject to change.

At this time, The Health Plan does not sponsor visa. Candidates must have legal and valid work authorization, Green Card, or U.S. citizenship.

We are currently hiring a Case Manager Nurse to join our team! This is a remote position. Must reside in California, preferably in our service area.

Continuously improve the health of our community.

We provide healthcare value and advance wellness through community partnerships.

Under general supervision, conducts case management activities on assigned members where analysis, synthesis and evaluation of data and information are required. In addition, this position is responsible for developing, implementing and evaluating individual care plans to ensure that care is rendered at the most appropriate level, for the requisite length of time, and in compliance with HPSJ, regulatory and contractual requirements.

Work is varied and complex and requires a moderate amount of discretion and independent judgement.

• Assesses and evaluates members care needs.
• Educates member on HPSJ services and the case management process.
• Develops complex care plans in partnership with member and member's PCP.
• Collaborates with member, his/her family, and external and internal resources to ensure understanding of and compliance with care plans.
• Escalates high risk medical issues to Medical Director for review; approves or denies services as directed.
• Monitors and evaluates progress at appropriate intervals; conducts appropriate interventions.
• Supports and advises members on self-advocacy efforts.
• Documents activities in appropriate HPSJ system(s) according to standards.
• Tracks data as required; compiles data for, produces and submits routine reports.
• Reviews care plans developed by LVN Case Managers and Entry Level Case Managers.

• Produces work that is accurate and complete.
• Produces the appropriate amount of work.
• Actively learns through experimentation when tackling new problems, using both successes and failures to learn.
• Rebounds from setbacks and adversity when facing difficult situations.
• Knows the most effective and efficient process to get things done, with a focus on continuous improvement.
• Strong clinical skills as defined in California scope of practice guidelines for RNs.
• In-depth knowledge of and proficient skills in administering protocols for utilization management, discharge planning and/or case management.
• In-depth knowledge of health care delivery systems as they apply to case management.
• Ability to read, interpret and apply clinical information, practice guidelines and other complex data and information.
• Strong skills in assessment and analysis.
• Strong problem-solving skills.
• Basic negotiation skills.
• Interpersonal skills - interacts effectively with individuals both inside and outside of HPSJ; relates openly and comfortably with diverse groups of people.
• Strong oral and written communication skills, with the ability to communicate professionally to diverse individuals inside and outside of HPSJ, effectively explain complex information, and document according to.
• Ability to use tact and diplomacy to diffuse emotional situations.
• Ability to work independently and as part of a team.
• Time management and organizational skills. Uses time effectively and efficiently. Values time. Concentrates his/her efforts on the more important priorities. Can attend to a broader range of activities. Meets deadlines.
• Strong customer service skills.
• Basic skills in Word and Excel.
• Ability to enter data into and navigate through multiple…